Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: A retrospective multicenter study

Table 1 Baseline characteristics of patients with pancreaticobiliary maljunction

Characteristic	n = 75
Age, yr	6 ± 3.4
Sex, male:female	23:52
Symptoms, n (%)
Abdominal pain	62 (82.7)
Vomiting	35 (46.7)
Acholic stool	4 (5.3)
Fever	3 (4.0)
Pancreatitis	47 (62.7)
Hyperbilirubinemia	13 (17.3)
Elevated liver enzymes	22 (29.3)
Accompanied diseases, n (%)
Pancreas divisum	7 (9.3)
Papillary diverticulum	4 (5.3)
Diaphragmatic duodenal atresia	2 (2.7)
Choledochal cyst	12 (16.0)
Biliary dilatation	46 (61.3)
Extrahepatic bile duct stones	44 (58.7)
Pancreatic protein plugs	18 (24.0)

Table 2 Clinical characteristics of and endoscopic retrograde cholangiopancreatography procedures used in four types of pancreaticobiliary maljunction

	Type A (n = 28)	Type B (n = 27)	Type C (n = 16)	Type D (n = 4)	P value
Age, mean ± SD, yr	5.7 ± 3.2	6.6 ± 3.8	5.2 ± 3.0	6.5 ± 4.2	0.398
Symptoms, n (%)
Abdominal pain	23 (82.1)	23 (85.1)	13 (81.2)	3 (75.0)	1.000
Vomiting	12 (44.4)	13 (48.1)	8 (50)	2 (50.0)	0.867
Acholic stool	3 (10.7)	0 (0)	0 (0)	1 (25.0)	0.175
fever	2 (7.1)	1 (3.7)	0 (0)	0 (0)	0.788
Pancreatitis	17 (60.7)	12 (44.4)	14 (87.5)	4 (100)	0.020
Hyperbilirubinemia	6 (21.4)	2 (7.4)	3 (18.8)	2 (50.0)	0.333
Elevated liver enzymes	12 (42.9)	4 (14.8)	3 (18.8)	3 (75.0)	0.058
Findings of ERCP, n (%)
Bile duct dilatation	21 (75.0)	13 (48.1)	9 (56.2)	3 (75.0)	0.122
Biliary stones	24 (85.7)	12 (44.4)	6 (37.5)	2 (50.0)	0.001
Pancreatic protein plugs	1 (3.6)	5 (18.5)	11 (68.8)	1 (25.0)	<0.001
Pancreatic duct stenosis or dilatation	2 (7.1)	3 (11.1)	11 (68.8)	1 (25.0)	<0.001
Procedures of ERCP, n (%)
EPS	4 (14.2)	6 (22.2)	7 (43.8)	2 (50.0)	0.092
EST	20 (71.4)	14 (51.9)	6 (36.5)	2 (50.0)	0.017
ERBD	11 (39.3)	3 (11.1)	3 (18.8)	0 (0)	0.049
ENBD	12 (42.9)	13 (48.1)	7 (43.8)	1 (25.0)	0.953
EPBD	1 (3.6)	1 (3.7)	0 (0)	0 (0)	1.000
ENPD	0 (0)	0 (0)	2 (12.5)	1 (25.0)	0.058
ERPD	2 (7.1)	3 (11.1)	3 (18.8)	0 (0)	0.499
Stone removal	16 (57.1)	11 (40.7)	12 (75.0)	1 (25.0)	0.088
Bougienage	2 (7.1)	1 (3.7)	2 (12.5)	0 (0)	0.628

The P value was the result of comparison between types A, B, and C. EPS: Endoscopic pancreatic sphincterotomy; EST: Endoscopic sphincterotomy; ERBD: Endoscopic retrograde biliary drainage; ENBD: Endoscopic nasobiliary drainage; EPBD: Endoscopic papillary balloon dilation; ENPD: Endoscopic nasopancreatic drainage; ERPD: Endoscopic retrograde pancreatic drainage; ERCP: Endoscopic retrograde cholangiopancreatography; SD: Standard deviation.

Table 3 Follow-up data of pancreaticobiliary maljunction pediatric patients after endoscopic retrograde cholangiopancreatography

Follow-up details
ERCP-related complications, n (%)	n = 75
Post-ERCP pancreatitis	9 (12.0)
Infection	2 (2.7)
Hemorrhage	1 (1.3)
Periampular perforation	0 (0)
Hospital stay, (mean ± SD), d	6 ± 4.1
Follow-up results1
Loss to follow-up, n (%)	7 (9.3)
Follow-up period, mean (range), mo	46 (2-134) (n = 68)
Effective rate, n (%)	56 (82.4)
Patients who underwent further ERCP therapy, n (%)	5 (7.4)
Patients who underwent the episode of pancreatitis again, n (%)	8 (11.8)
Patients who underwent radical surgery, n (%)	11 (16.2)
Patients who underwent cholangitis, n (%)	2 (2.9)

¹The seven patients who were lost to follow-up were excluded in the statistical analyses. ERCP: Endoscopic retrograde cholangiopancreatography; SD: Standard deviation.