Journal of Surgery Concepts & Practice >

2020 , Vol. 25 >Issue 06: 468 - 472

DOI: https://doi.org/10.16139/j.1007-9610.2020.06.005

Original article

Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction：a report of 74 cases

Expand
  • Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received date: 2020-10-30

  Online published: 2022-07-20

Fold

Abstract

Objective To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pediatric pancreaticobiliary maljunction(PBM). Methods A total of 74 children with PBM diagnosed by ERCP were enrolled. The clinical data with postoperative follow-up were analyzed. Results There were 32 cases with type A, 16 cases with type B, 23 cases with type C and 3 cases with type D based on the classification of PBM proposed by Japanese Study Group on PBM. The positive diagnostic rate of PBM was only 8% using MRCP. All children underwent endoscopic sphincteropapillotomy with endoscopic nasobiliary drain of which 69 cases(93.4%) were preceded with extraction of pancreatic protease emboli or stones. Pancreatic stent was followed in 2 cases. Seven cases (9.5%) had mild pancreatits after ERCP. No bleeding or cardiac laceration and perforations were found. The children had resection of extrahepatic bile duct combined with hepatic duct jejunum Roux-en-Y anastomotisis except for 7(9.5%) cases without biliary dilatation. Conclusions ERCP could be performed safely with effective diagnosis and treatment in pediatric PBM, and is an important procedure for children with PBM during early stage.

Key words： Pancreaticobiliary maljunction; Endoscopic retrograde cholangiopancreatography; Pediatric; Congenital common bile duct dilatation

Cite this article

WENG Mingzhe, WENG Hao, TAO Yijing, GU Jun, ZHANG Wenjie, WANG Xuefeng . Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction：a report of 74 cases[J]. Journal of Surgery Concepts & Practice, 2020 , 25(06) : 468 -472 . DOI: 10.16139/j.1007-9610.2020.06.005

References

[1] Misra SP, Dwivedi M. Pancreatico biliary ductal union[J]. Gut, 1990, 31(10):1144-1149.
[2] Kamisawa T, Kuruma S, Tabata T, et al. Pancreaticobi-liary maljunction and biliary cancer[J]. J Gastroenterol, 2015, 50(3):273-279.
[3] Kamisawa T, Ando H, Hamada Y, et al. Diagnostic criteria for pancreaticobiliary maljunction 2013[J]. J Hepatobiliary Pancreat Sci, 2014, 21(3):159-161.
[4] Urushihara N, Hamada Y, Kamisawa T, et al. Classification of pancreaticobiliary maljunction and clinical features in children[J]. J Hepatobiliary Pancreat Sci, 2017, 24(8):449-455.
[5] Troendle DM, Abraham O, Huang R, et al. Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population[J]. Gastrointest Endosc, 2015, 81(6):1408-1416.
[6] Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb[J]. Ann Radiol, 1969, 12(3):231-240.
[7] Turowski C, Knisely AS, Davenport M. Role of pressure and pancreatic reflux in the aetiology of choledochal malformation[J]. Br J Surg, 2011, 98(9):1319-1326.
[8] Shimada K, Yanagisawa J, Nakayama F. Increased lysophosphatidylcholine and pancreatic enzyme content in bile of patients with anomalous pancreaticobiliary ductal junction[J]. Hepatology, 1991, 13(3):438-444.
[9] Kaneko K, Ando H, Seo T, et al. Proteomic analysis of protein plugs: causative agent of symptoms in patients with choledochal cyst[J]. Dig Dis Sci, 2007, 52(8):1979-1986.
[10] Mizuno M, Kato T, Koyama K. An analysis of mutagens in the contents of the biliary tract in pancreaticobiliary maljunction[J]. Surg Today, 1996, 26(8):597-602.
[11] Morine Y, Shimada M, Takamatsu H, et al. Clinical features of pancreaticobiliary maljunction: update analysis of 2nd Japan-nationwide survey[J]. J Hepatobiliary Pancreat Sci, 2013, 20(5):472-480.
[12] Wistuba II, Gazdar AF. Gallbladder cancer: lessons from a rare tumour[J]. Nat Rev Cancer, 2004, 4(9):695-706.
[13] Kimura K, Ohto M, Saisho H, et al. Association of gall bladder carcinoma and anomalous pancreaticobiliary duct union[J]. Gastroenterology, 1985, 89(6):1258-1265.
[14] Komi N, Udaka H, Ikeda N, et al. Congenital dilatation of the biliary tract: new classification and study with particular reference to anomalous arrangement of the pancreaticobiliary ducts[J]. Gastroenterol Jpn, 1977, 12(4):293-304.
[15] Yoshimoto K, Kamisawa T, Kikuyama M, et al. Classification of pancreaticobiliary maljunction and its clinical features in adults[J]. J Hepatobiliary Pancreat Sci, 2019, 26(12):541-547.
[16] Tsuchiya H, Kaneko K, Itoh A, et al. Endoscopic biliary drainage for children with persistent or exacerbated symptoms of choledochal cysts[J]. J Hepatobiliary Pancreat Sci, 2013, 20(3):303-306.
[17] Cheng CL, Fogel EL, Sherman S, et al. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report[J]. J Pediatr Gastroenterol Nutr, 2005, 41(4):445-453.
[18] Otto AK, Neal MD, Slivka AN, et al. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases[J]. Surg Endosc, 2011, 25(8):2536-2540.
[19] Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group[J]. Pediatr Surg Int, 2007, 23(2):111-116.
[20] Todani T, Watanabe Y, Toki A, et al. Carcinoma related to choledochal cysts with internal drainage operation[J]. Surg Gynec Obstet, 1987, 164(1):61-64.
Options
Outlines

/

〈 〉