Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2019; 25(40): 6107-6115
Published online Oct 28, 2019. doi: 10.3748/wjg.v25.i40.6107
Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: A retrospective multicenter study
Jing-Qing Zeng, Zhao-Hui Deng, Kai-Hua Yang, Tian-Ao Zhang, Wen-Yu Wang, Jian-Mei Ji, Ya-Bin Hu, Chun-Di Xu, Biao Gong
Jing-Qing Zeng, Zhao-Hui Deng, Kai-Hua Yang, Tian-Ao Zhang, Wen-Yu Wang, Department of Pediatric Digestive Diseases, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Jian-Mei Ji, Biao Gong, Department of Digestive Diseases, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Ya-Bin Hu, Department of Clinical Epidemiology and Biostatistics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Chun-Di Xu, Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: Zeng JQ and Deng ZH contributed equally to this article; Deng ZH and Gong B made substantial contributions to conception and design of the study; Zeng JQ, Yang KH, Zhang TA, Wang WY, Ji JM, and Xu CD contributed to acquisition, analysis, or interpretation of the data; Hu YB performed the statistical analysis; Zeng JQ drafted the article and made critical revisions related to important intellectual content of the manuscript; all the authors have read and approved the final version to be published.
Supported by the Shanghai Municipal Health Bureau, No. ZY (2018-2020)-FWTX-1105.
Institutional review board statement: This study was approved by the Institutional Ethnic Committee of Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine.
Informed consent statement: Informed consent was obtained from each patient.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Biao Gong, MD, Chief Doctor, Department of Digestive Diseases, Shanghai Shuguang Hospital, Shanghai University of Chinese Medicine, Shanghai 201203, China. gongbiaoercp@163.com
Telephone: +86-21-53821650 Fax: +86-21-58393915
Received: August 9, 2019
Peer-review started: August 9, 2019
First decision: August 27, 2019
Revised: September 18, 2019
Accepted: September 27, 2019
Article in press: September 28, 2019
Published online: October 28, 2019
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in pediatric patients with cholangiopancreatic diseases.

AIM

To evaluate the efficacy, safety, and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction (PBM).

METHODS

A multicenter, retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019. They were divided into four PBM groups based on the fluoroscopy in ERCP. Their clinical characteristics, specific ERCP procedures, adverse events, and long-term follow-up results were retrospectively reviewed.

RESULTS

Totally, 112 ERCPs were performed on the 75 children with symptomatic PBM. Clinical manifestations included abdominal pain (62/75, 82.7%), vomiting (35/75, 46.7%), acholic stool (4/75, 5.3%), fever (3/75, 4.0%), acute pancreatitis (47/75, 62.7%), hyperbilirubinemia (13/75, 17.3%), and elevated liver enzymes (22/75, 29.3%). ERCP interventions included endoscopic sphincterotomy, endoscopic retrograde biliary or pancreatic drainage, stone extraction, etc. Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis (9/75, 12.0%), gastrointestinal bleeding (1/75, 1.3%), and infection (2/75, 2.7%). During a mean follow-up period of 46 mo (range: 2 to 134 mo), ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis. The overall effective rate of ERCP therapy was 82.4%; seven patients (9.3%) were lost to follow-up, eight (11.8%) re-experienced pancreatitis, and eleven (16.2%) underwent radical surgery, known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy.

CONCLUSION

ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM, with the characteristics of minor trauma, fewer complications, and repeatability.

Keywords: Cholangiopancreatic diseases, Endoscopic retrograde cholangiopancreatography, Pancreaticobiliary maljunction, Pancreatitis, Pediatric patients, Follow-up

Core tip: The research on the use of endoscopic retrograde cholangiopancreatography (ERCP) for management of pancreaticobiliary maljunction (PBM), especially among pediatric patients, is limited. This retrospective, multicenter study aimed to evaluate the overall safety and efficacy of ERCP to treat children with symptomatic PBM. A retrospective review of the clinical characteristics/conditions of 75 pediatric patients who were diagnosed with PBM, specific ERCP procedures, and their long-term follow-up showed that ERCP is safe and effective for treatment of symptomatic PBM, with limited post-procedural complications among pediatric patients.