Value Of Endoscopic Retrograde Cholangiopancreatography In Children With Pancreaticobiliary Diseases

Background and ObjectiveIn 1974 the first case of endoscopic sphincterotomy(EST)opened a new chapter of endoscopic retrograde cholangiopancreatography(ERCP)in the diagnosis and treatment of pancreaticobiliary diseases.After nearly half a century of the development,ERCP has become an indispensable method in the diagnosis and treatment of pancreaticobiliary diseases among the adults.The effectiveness and the safety of ERCP have been confirmed and widely used in the adults who are with pancreaticobiliary diseases.However,since the digestive tract of children is still under development stage,the tract wall is thin,and the lumen is small.Children also has poor tolerance and cooperation,as well as the lack of experience of operating physicians.Therefore,ERCP is not often used in children's pancreaticobiliary diseases[1].In recent years,with the enhancement of ERCP operation skills,the increasing experience of children's ERCP operation,and the upgrading of children's endoscope related equipment,ERCP has gradually been applied to more children with pancreaticobiliary diseases.However,there are still few reports on ERCP in children in our country.Therefore,further research is needed.Through analyzing the clinical data of children under 14 years old who were performed ERCP surgery for different pancreaticobiliary diseases(such as bile duct stones,biliary stricture,chronic pancreatitis,etc),this study aimed to evaluate the value and the security of ERCP in the diagnosis and treatment of pancreaticobiliary diseases of children.MethodsRetrospective analysis was conducted on the clinical data of 33 cases of children under 14 years of age,who were underwent ERCP in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2020 for various pancreaticobiliary diseases.Statistical analysis was then conducted based on the children's general data,etiologies,ERCP operation methods,diagnosis and treatment results and postoperative complications.Qualitative data were compared by the ?2 test of multiple independent samples and P<0.05 was considered statistically significant.Results1.There was a total of 38 ERCP surgeries on 33 children,among which 28 cases received only one ERCP,and 5 cases received twice.There were 5 failed surgeries,making a success rate of 89.47%(34/38).2.There were 33 children received ERCP diagnosis and treatment,where 23 cases were diagnosed with simple biliary tract diseases,including 16 cases of choledocholithiasis,5 cases of biliary stricture/dilatation,1 case of choledocholithiasis with biliary stricture,and 1 case of suspected biliary ascariasis residual;7 cases were diagnosed with simple disease of pancreas,including 3 cases of chronic pancreatitis(one with pancreatolithiasis and pancreatic pseudocyst,one with pancreatolithiasis,and the other one with pancreatic duct stenosis),1 case of acute pancreatitis with pancreatic divisum,1 case of pancreatic pseudocyst,and 2 cases of postoperative pancreatic duct stent implantation;3 cases were diagnosed with both of them,including 2 cases of biliary pancreatitis(one with choledocholithiasis,the other one with congenital choledochal cyst),1 case of pancreaticobiliary maljunction with choledocholithiasis.3.A total of 17 procedures were used in 33 children.Among them,29 cases(87.88%)had smooth ERCP treatment,abdominalpain,nausea and vomiting were alleviated obviously,and abnormal indexes suchas liver function and amylase gradually returned to normal.4.The rate of postoperative complication of ERCP was 15.79%(6/38),including 3 cases of hyperamylaseemia(7.89%),2 cases of postoperative pancreatitis(5.26%),and 1 case of abdominal pain(2.63%).There were no serious postoperative complications such as gastrointestinal bleeding and infection of biliary tract.And those 6 children with postoperative complications was stable after conservative medical treatment.Conclusions1.In children's pancreaticobiliary diseases,the incidence of biliary and pancreatic congenital anatomic abnormalities is more common,whereas the incidence of malignant lesions is lower.2.As an invasive operation,ERCP may come with certain complications.The indications for applying ERCP should be strictly reviewed.ERCP is a relatively safe and effective diagnosis and treatment method for children with pancreaticobiliary disease that has high application value.3.ERCP which is a relatively safe and effective way to diagnose and treat children with pancreaticobiliary diseases has high application value.