Usefulness and safety of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary maljunction

Significance of imaging modalities for preoperative evaluation of the pancreaticobiliary system in surgery for pediatric choledochal cyst

“…The reported visualization rates of PBM in pediatric CC by ERCP have been fairly high, ranging from 50% to 90.5% . Hiramatsu et al obtained the highest rate of 90.5%, compared to 37.9% with MRCP . The present study demonstrated that the rates obtained by MRCP (57%) and DIC‐CT (25%) were significantly lower than the rate of ERCP (82%), but that IOCP had a rate of 87%, comparable to that of ERCP.…”

“…Since congenital biliary strictures near the hepatic hilum can trigger postoperative cholangitis , hepatolithiasis , and possibly carcinogenesis , these strictures should be treated prior to conventional bilioenterostomy . Thus, both pre‐ and intraoperative investigation into the intrahepatic biliary morphology is imperative; but the imaging modality most appropriate for visualization of intrahepatic biliary morphology in children remains uncertified . The present study substantially demonstrated the superiority of MRCP (100%), IOCP (100%), and DIC‐CT (90%) over ERCP (32%), with statistically significant differences.…”

“…Our relatively lower visualization rate of ERCP may be due to the fact that our endoscopists were hesitant to inject a considerable amount of contrast medium into the dilated CBD of small children, due to concerns over post‐ERCP complications. In fact, a study by Hiramatsu et al reported a relatively higher frequency of post‐ERCP hyperamylasemia, at 19%, compared to previous studies . Interestingly, a combination of MRCP and IOCP achieved a rate of 89% with no significant difference compared to ERCP.…”

“…A recently published guideline for PBM has recommended the use of direct cholangiography as a method of delineating PBM precisely . The reported visualization rates of PBM in pediatric CC by ERCP have been fairly high, ranging from 50% to 90.5% . Hiramatsu et al obtained the highest rate of 90.5%, compared to 37.9% with MRCP .…”

“…In the setting of pediatric CC, a variety of imaging modalities, including ultrasonography (US), magnetic resonance cholangiopancreatography (MRCP) , endoscopic retrograde cholangiopancreatography (ERCP) , drip infusion cholangiography with computed tomography (DIC‐CT) , and intraoperative cholangiopancreatography (IOCP) , have been used, not only to facilitate diagnosis, but also to obtain detailed pancreaticobiliary morphological anatomy. With the growing public awareness of the side‐effects of these modalities, their selection and indication have often become a matter of debate, particularly regarding children.…”