The role of endoscopic retrograde cholangiopancreatography in choledochal cysts and/or abnormal pancreatobiliary junction in children

Abstract

IntroductionBiliary cysts with an abnormal pancreatobiliary junction are one of the most common pancreatobiliary malformations. The main symptom is cholestasis; endoscopic retrograde cholangiopancreatography (ERCP) plays a key role in diagnosis.AimRetrospective evaluation of ERCP performed to diagnose abnormalities of the pancreatobiliary junction.Material and methodsWe retrospectively evaluated ERCP performed to diagnose abnormalities of the pancreatobiliary junction, mainly choledochal cysts, in 112 children between 1990 and 2011.ResultsWe performed 112 examinations of 50 children with abnormal pancreatobiliary junction and choledochal cysts (15 males and 35 females, average age: 5 years, range: 1 month – 15 years). Cysts were associated with a common channel in 37 (74%) cases, were not associated with a common channel in 9 (18%) cases, and in 3 (6%) cases the common channel lacked cysts. We performed endoscopic papilla sphincterotomy on 33 (66%) patients; endoscopic drainage was performed 62 times, including 17 patients without papilla sphincterotomy. In 15 (30%) cases, we only performed sphincterotomy. Extraction of lithiasis was done in 2 (4%) cases. Both ERCP and magnetic resonance cholangiopancreatography (MRCP) were performed on 13 patients. There was concordance of the choledochal cyst and of the type of cyst in both methods; however, common channels could not be observed by MRCP. There was 1 serious complication (perforation after sphincterotomy) and 11 (9%) mild adverse events.ConclusionsWhen performed at an expert centre, ECRP is a safe and reliable procedure for children with choledochal cysts and/or an abnormal pancreatobiliary junction. Endoscopic retrograde cholangiopancreatography remains a reasonable alternative because MRCP has a limited ability to diagnose the precise anomalies of the pancreatobiliary junction and has no therapeutic capabilities.

Minor Papillary Relief in a Type IA Choledochal Cyst: A Case Report and Review of the Literature

“…The distal and intraduodenal portions of the CBD, however, are beyond the reach of PTHC. Complications of both ERCP and PTHC include pancreatitis from manipulation, cholangitis from the large amount of contrast needed, bleeding, and perforation [7,15]. CT with contrast and CT cholangiography have a 90% sensitivity for diagnosis, but carry the risk of contrast and radiation along with cholangiography having poor illumination of the pancreatic duct [15].…”

“…Complications of both ERCP and PTHC include pancreatitis from manipulation, cholangitis from the large amount of contrast needed, bleeding, and perforation [7,15]. CT with contrast and CT cholangiography have a 90% sensitivity for diagnosis, but carry the risk of contrast and radiation along with cholangiography having poor illumination of the pancreatic duct [15]. Magnetic resonance imaging and MRCP have a sensitivity of 90-100% and do not carry the risks of contrast or radiation, but it will miss CC that are too small resulting in a higher number of false negatives [6,7,15].…”

“…CT with contrast and CT cholangiography have a 90% sensitivity for diagnosis, but carry the risk of contrast and radiation along with cholangiography having poor illumination of the pancreatic duct [15]. Magnetic resonance imaging and MRCP have a sensitivity of 90-100% and do not carry the risks of contrast or radiation, but it will miss CC that are too small resulting in a higher number of false negatives [6,7,15]. This has led to ERCP as the current gold standard in both its diagnostic and therapeutic value in CC by capturing biopsies, papilla sphincterotomy, removal of cholelithiasis, and creating patent drainage [15].…”

“…Magnetic resonance imaging and MRCP have a sensitivity of 90-100% and do not carry the risks of contrast or radiation, but it will miss CC that are too small resulting in a higher number of false negatives [6,7,15]. This has led to ERCP as the current gold standard in both its diagnostic and therapeutic value in CC by capturing biopsies, papilla sphincterotomy, removal of cholelithiasis, and creating patent drainage [15]. Differential diagnosis includes biliary atresia that must be ruled out in neonates as a cause of obstructive jaundice, as well as lithiasis in any part of the biliary tract [7].…”

Pediatric Choledochal Cysts: Unknowns are Decreasing

“…Most commonly, the ducts above (right, left, and intrahepatic ducts) and below of the CC are not dilated [14], except type Ic. In type Ic, cyst extends continuously to the common hepatic duct or intrahepatic ducts [62]. Type I CCs, along with type IV cysts, have the highest risk of malignancy [10].…”