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Gastroenterology Review/Przegląd Gastroenterologiczny
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Artykuł oryginalny

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

Jiri Drabek, Radan Keil, Jan Stovicek, Jindra Lochmannova, Stepan Hlava, Jiri Snajdauf, Michal Rygl, Jiri Nevoral

Data publikacji online: 2017/12/14
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Introduction: Biliary 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.

Aim: Retrospective evaluation of ERCP performed to diagnose abnormalities of the pancreatobiliary junction.

Material and methods: We retrospectively evaluated ERCP performed to diagnose abnormalities of the pancreatobiliary junction, mainly choledochal cysts, in 112 children between 1990 and 2011.

Results: We 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.

Conclusions: When 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.
Singham J, Yoshida EM, Scudamore CH. Choledochal cysts, classification and pathogenesis. J Can Chir 2009; 52: 434-8.
Yamaoka K, Tazawa J, Koizumi K, et al. Choledochocele with obstructive jaundice: a case report and a review of the Japanese literature. J Gastroenterol 1994; 29: 661-4.
ONeill JA Jr. Choledochal cysts. Curr Probl Surg 1992; 29: 361-410.
Alonso-Lej F, Rever WB, Pessango DJ. Congenital choledochal cyst with a report of 2, and analysis of 94 cases. Int Abstr Surg 1959; 108: 1-30.
Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts, classification, operative procedures and review of thirty-seven CASE including cancor arising from choledochal cyst. Am J Surg 1977; 134: 263-9.
Babbit DP. Congenital choledochal cysts: new ethiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris) 1969; 12: 231-40.
Cheng SP, Yang TL, Jeng KS, et al. Choledochal cysts in adults: aetiological considerations to intrahepatic involvement. ANZ J Surg 2004; 74: 964-7.
Yotsuynagy S. Contribution to aetiology and pathology of idiopathic cystic dilatation of the common bile duct with report of three cases. Gann 1936; 30: 601-752.
Levy AD, Rohrman CA. Biliary cystic disease. Curr Probl Dian Radiol 2003; 32: 233-63.
Fulcher AS, Turner MA, Sanyal AJ. Case 38: Caroli’s disease and renal tubular ectasia. Radiology 2001; 220: 720-2.
Tsuchiya R, Harada N, Ito T, et al. Malignant tumors in choledochal cysts. Ann Surg 1977; 186: 22-8.
Lam WM, Lam TP, Saing H. MR cholangiography and CT cholangiography of pediatric patients with choledochal cysts. AJR Am Roentgenol 1999; 173: 401-5.
Kim MJ, Han SJ, Yoon CS, et al. Cholangiopancreatography to reveal anomalous pancreatobiliary ductal union in infants and children with choledochal cysts. AJR Am J Roentgenol 2002; 179: 209-14.
Arhanskiy Y, Vyas PK. Type IV. Choledochal cyst presenting with obstructive jaundice: role of MR cholangiopancreatography in preoperative evaluation. AJR Am J Roentgenol 1998; 171: 457-8.
Pietrabissa A, Boggi U, Di Candio G, et al. Unsuspected choledochal cyst during laparostopic cholecystectomy. Surg Endosc 1995; 9: 1127-9.
Keil R, Šnajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates – a retrospective study on large series. Endoscopy 2010; 42: 121-6.
Park KB, Auh YH, Kim JH, et al. Diagnostic pitfails in the cholangiopancreatographic diagnosis of choledochoceles: cholangiographic duality and its effect on visualisation. Abdom Imaging 2001; 26: 48-54.
Sawyer M. Imaging in choledochal cyst. Emedicine.medscape.com/article/366004-overview, Apr 12, 2011.
Norton KI, Glass RB, Kogan D, et al. MR cholangiography in the evaluation of neonatal cholestasis: initial results. Radiology 2002; 222: 687-91.
Chavhan GB, Babyn PS, Manson D, et al. Cholangiography: principles, technique and clinical applications. Radiographics 2008; 28: 1951-62.
Park DH, Kim M, Lee SK, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts ? Gastrointest Endosc 2005; 62: 360-6.
Schaefer JF, Kirschner HJ, Lichy M, et al. Highly resolved free-breathing magnetic resonance cholangiopancreatography in the diagnostic workup of pancreatobiliary diseases in infants and young children – initial experiences. J Pediatr Surg 2006; 41: 1645-51.
Guideline for the evaluation of cholestatic jaundice in infants: Recomendation of the North American Society for Pediatric Gastroenterology, Hematology and Nutrition. J Pediatr Gastroenterol Nutr 2004; 39: 115-28.
Keil R., Šnajdauf J, Štuj J, et al. Endoscopic retrograde cholangiopancreatography in cholestatic infants – our experience. Endoscopy 2003; 35 (Suppl II): A225.
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