Published online Oct 28, 2019. doi: 10.3748/wjg.v25.i40.6107
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
Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in pediatric patients with cholangiopancreatic diseases.
To evaluate the efficacy, safety, and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction (PBM).
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.
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.
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.
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.