Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Endoscopic retrograde cholangiopancreatography (ERCP) as an important technological innovation has been used in the field of biliary and pancreatic diseases in children. Pediatric patients with pancreaticobiliary maljunction (PBM) often experience some complications, such as obstructive jaundice or acute pancreatitis. ERCP can be used to improve drainage and resolve complications.
Research motivation
With continuous technical advancements, ERCP is not only regarded as a standard technique for diagnosing PBM but is also used to resolve complications. Nonetheless, there is limited research regarding the use of ERCP for the management of PBM, especially for pediatric patients.
Research objectives
The objective of this study was to retrospectively review the efficacy, safety, and long-term follow-up results of ERCP in symptomatic PBM.
Research 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.
Research results
A total of 112 ERCPs were performed on the 75 children with symptomatic PBM. Clinical manifestations mainly included abdominal pain, vomiting, acholic stool, fever, acute pancreatitis, hyperbilirubinemia, and elevated liver enzymes. 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, the overall effective rate of ERCP therapy was 82.4%, and ERCP therapy can alleviate the biliary obstruction and reduce the incidence of pancreatitis.
Research conclusions
As a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM, ERCP is characterized by minor trauma, fewer complications, and repeatability.
Research perspectives
Our findings further expanded the application scope of ERCP in biliopancreatic diseases. ERCP can serve as a transitional step to definitive surgery for PBM patients. It can guarantee pancreaticobiliary drainage, relieve clinical symptoms, and is only associated with a low incidence of mild complications. Future prospective studies are needed to investigate the effect of ERCP in patients with PBM to further support our findings.
