Published online Oct 28, 2019. doi: 10.3748/wjg.v25.i40.6107
Peer-review started: August 9, 2019
First decision: August 27, 2019
Revised: September 18, 2019
Accepted: September 27, 2019
Article in press: September 28, 2019
Published online: October 28, 2019
Processing time: 79 Days and 23.4 Hours
Endoscopic retrograde cholangiopancreatography (ERCP) as an important technological innovation has been used in the field of biliary and pancreatic diseases in children. Pediatric patients with pancreaticobiliary maljunction (PBM) often experience some complications, such as obstructive jaundice or acute pancreatitis. ERCP can be used to improve drainage and resolve complications.
With continuous technical advancements, ERCP is not only regarded as a standard technique for diagnosing PBM but is also used to resolve complications. Nonetheless, there is limited research regarding the use of ERCP for the management of PBM, especially for pediatric patients.
The objective of this study was to retrospectively review the efficacy, safety, and long-term follow-up results of ERCP in symptomatic PBM.
A multicenter, retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019. They were divided into four PBM groups based on the fluoroscopy in ERCP. Their clinical characteristics, specific ERCP procedures, adverse events, and long-term follow-up results were retrospectively reviewed.
A total of 112 ERCPs were performed on the 75 children with symptomatic PBM. Clinical manifestations mainly included abdominal pain, vomiting, acholic stool, fever, acute pancreatitis, hyperbilirubinemia, and elevated liver enzymes. ERCP interventions included endoscopic sphincterotomy, endoscopic retrograde biliary or pancreatic drainage, stone extraction, etc. Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis (9/75, 12.0%), gastrointestinal bleeding (1/75, 1.3%), and infection (2/75, 2.7%). During a mean follow-up period of 46 mo, the overall effective rate of ERCP therapy was 82.4%, and ERCP therapy can alleviate the biliary obstruction and reduce the incidence of pancreatitis.
As a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM, ERCP is characterized by minor trauma, fewer complications, and repeatability.
Our findings further expanded the application scope of ERCP in biliopancreatic diseases. ERCP can serve as a transitional step to definitive surgery for PBM patients. It can guarantee pancreaticobiliary drainage, relieve clinical symptoms, and is only associated with a low incidence of mild complications. Future prospective studies are needed to investigate the effect of ERCP in patients with PBM to further support our findings.