Application of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of pediatric common bile duct stone disease

Abstract

BACKGROUND

Biliary obstruction is an important pathological condition in childhood, with complex etiologies and often non-specific clinical manifestations. Children with suspected biliary obstruction commonly present with clinical symptoms such as jaundice, abdominal pain, fever, vomiting, and abnormal liver function biochemical markers, including significantly elevated serum total bilirubin, direct bilirubin, alkaline phosphatase, γ-glutamyltransferase, and transaminase levels. Common causes include common bile duct stones, biliary tract infections, choledochal cysts, abnormal pancreatobiliary junction, and acute or chronic pancreatitis. Among these, if common bile duct stones are not promptly and effectively managed, they may progress to severe complications such as suppurative cholangitis and biliary pancreatitis, which not only exacerbate the condition but may also cause long-term adverse effects on the child’s growth, development, and quality of life.

AIM

To explore the application value of endoscopic retrograde cholangiopancreatography (ERCP) technology in pediatric common bile duct stone disease and summarize the pediatric experience.

METHODS

Clinical data of children suspected of biliary obstruction who received ERCP treatment in the Department of General Surgery at Anhui Provincial Children’s Hospital from May 2022 to June 2025 were collected. The clinical characteristics were summarized, changes in liver function before and after ERCP were compared, ERCP procedures and postoperative complications were recorded.

RESULTS

A total of 62 children with suspected biliary obstruction underwent 101 ERCP procedures, of which 97 were successful and 4 failed. The diagnoses were clarified as 20 cases of common bile duct stones, 15 cases of biliary infection, 22 cases of choledochal cysts, 6 cases of abnormal pancreatobiliary junction, and 10 cases of acute/chronic pancreatitis. Among these, 20 children with common bile duct stones underwent 29 ERCP procedures, with no failures. The procedures included 5 papillary sphincterotomies, 2 stone extractions using a basket, 18 stone extractions using a balloon, 18 balloon dilations, 13 bile duct stent insertions, 7 nasobiliary drainages, and 9 bile duct stent removals. The average duration of ERCP was 54.2 ± 18.7 minutes, and the average hospital stay was (7.0 ± 2.8) days. The average liver function indicators 3 days after the first ERCP procedure were significantly lower than before the procedure, with a statistically significant difference (P < 0.05). The complication rate after common bile duct stone extraction was 6.9% (2/29), with both cases being post-operative pancreatitis, which improved after symptomatic treatment such as acid suppression and enzyme inhibition.

CONCLUSION

ERCP technology can assist in determining the etiology of children with suspected biliary obstruction before surgery, especially in the treatment of biliary obstruction caused by common bile duct stones, proving to be both safe and effective.

Keywords: Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Biliary obstruction; Pediatrics; Treatment

Core Tip: This study demonstrates that endoscopic retrograde cholangiopancreatography (ERCP) is a safe and effective minimally invasive technique for both diagnosing and treating common bile duct stones in children. It achieved a 100% technical success rate in 29 procedures for 20 pediatric common bile duct stones patients, significantly improving liver function with a low complication rate (6.9%, all mild post-ERCP pancreatitis). ERCP is a valuable tool for managing biliary obstruction in children, offering precise diagnosis and therapeutic intervention.