Usefulness of pre‐operative endoscopic retrograde cholangiopancreatography in diagnosis and management of forme fruste choledochal cyst in children

Abstract

BackgroundForme fruste choledochal cyst (FFCC), characterized by a minimally dilated common bile duct (CBD) and associated pancreaticobiliary maljunction (PBM), is difficult to diagnose in a timely manner in clinical practice. However, endoscopic retrograde cholangiopancreatography (ERCP) can clearly delineate CBD and PBM. Hence, we evaluated the value of ERCP in the diagnosis and management of FFCC.MethodsThe medical records of patients diagnosed with FFCC were retrospectively reviewed. From January 2003 to December 2010, patients underwent surgery without ERCP (non‐ERCP group); from January 2011, all patients underwent pre‐operative ERCP (ERCP group). Demographics, laboratory results, perioperative data and post‐operative complications were compared between the two groups.ResultsThere were 24 patients in the ERCP group and 11 in the non‐ERCP group. Laboratory data improved to a greater extent after ERCP. ERCP was superior to both magnetic resonance cholangiopancreatography and ultrasonography in delineating CBD and PBM. In the ERCP group, 20 of the 24 patients were noted to have filling defects in the biliary tract and underwent pre‐operative endoscopic sphincterotomy. Intra‐operative blood loss was lower and transfusion less frequent in the ERCP group (P < 0.05). There were no ERCP‐related complications.ConclusionsERCP can accurately delineate the minimal CBD dilatation, associated pancreaticobiliary tract abnormalities and PBM of FFCC. ERCP can improve the perioperative and post‐operative results of paediatric patients with FFCC.

Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study

“…In infants, MRCP may not visualize healthy extrahepatic bile ducts and can lead to false positivity for the diagnosis of neonatal cholestatic diseases [10]. ERCP visualizes the biliary tree in infants with a high success rate and may avoid unnecessary surgery if biliary ▶ atresia is excluded [11,12]. In our study, 10 % of ERCP procedures were diagnostic for cases of neonatal cholestasis only.…”

Clinical comparison between the presence and absence of protein plugs in pediatric choledochal cysts: experience in 390 patients over 30 years in a single center

“…Preoperative therapeutic biliary drainage in patients with CC with persistent or exacerbated symptoms is considered to help make the surgery easier to perform and help them recover rapidly after surgery [ 28 29 ]. A previous group that underwent biliary drainage through ERCP before surgery had significantly less intraoperative blood loss and transfusion and shorter postoperative length of stay than a group that did not [ 30 ]. Younger patients are known to have higher risks for complications with ERCP [ 31 32 ]; however, recent studies have shown that the efficacy and safety of ERCP in infants and children are comparable to those in adults [ 23 33 34 35 ].…”

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children

“…The final goal of treatment is resection of the dilated common bile duct and reconstruction of the biliary system. ERCP is useful in preoperative diagnosis and management of complications 53 …”