Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: A preliminary report

Abstract

An anomalous elongated pancreaticobiliary common channel encourages reflux up both the biliary tree and the pancreatic ductal system, resulting in progressive choledochal dilatation, cholangitis with ductal calculi, relapsing pancreatitis and malignant change. Transduodenal sphincteroplasty has been used to improve drainage from the abnormal channel. The use of endoscopic sphincterotomy (ES) to establish drainage and minimize the surgical risks is reported in six symptomatic patients with mild choledochal dilatation (common bile duct diameter less than 15 mm), a common channel less than 15 mm in length and a distal stenosis. This was successful in five patients, who have no further symptoms. ES failed in the only patient with an undilated common channel and this patient went on to have open surgery. We believe ES to be safe and effective in the treatment of selected cases of long common channel.

Endoscopic Therapy for Patients With Pancreaticobiliary Maljunction: A Follow-up Study

“…Ng [2] and Terui [7] have speculated that EST was less effective in PBM patients with undilated common channel, however, the sample size was quite small. Thus we performed a further analysis to compare the benefit of EST on patients with undilated common channel and patients with dilated common channel.…”

“…Published literature on the use of ERCP in PBM is limited to small series. Ng et al [2] first reported 6 PBM patients who underwent EST, five got satisfactory outcomes. Similarly, Guelrud et al [3] showed that following a mean 26.4 months in 9 PBM patients who underwent ERCP therapy, eight had excellent results.…”

“…Oncotarget 44861 www.impactjournals.com/oncotarget Nonetheless, Data on the experience of ERCP in the management of PBM are limited to small series [2][3][4][5][6][7][8][9][10]. Two studies speculated that endoscopic sphincterotomy (EST) was less effective in those patients with undilated common channel, but their sample size was quite small [2,7].…”

ERCP in children

“…In most patients, endoscopic sphincterotomy is probably not indicated, and endoscopic access to the biliary system for removal of stones or sludge is therefore not possible. In selected cases, with fusiform bile duct dilatation and widely dilated common channel, endoscopic sphincterotomy has been attempted, with encouraging results [34]. In patients with Caroli's disease, liver transplantation may be required [35].…”

Endoscopic treatment of choledochocele

“…The intriguing point is that subsequent to our preliminary report on endoscopic treatment for fusiform choledochal cyst in six children 5 years ago, this is the only comprehensive case report using the same approach for the same anomaly [3]. The apparent paucity of contemporary reports may be due to the small number of cases fulfilling the rather stringent selection criteria (including the size of the common bile duct) or to prevailing concerns about the long-term results [3].…”