A newly developed small-caliber videoduodenoscope for endoscopic retrograde cholangiopancreatography in children.

Abstract

In neonates and younger children, the procedure of endoscopic retrograde cholangiopancreatography (ERCP) is now optimally performed using a small-caliber fiberoptic duodenoscope. However, there have been no reports on a specially designed videoduodenoscope for pediatric ERCP. To evaluate performance and clinical usefulness of a newly developed small-caliber videoduodenoscope for ERCP in children. We have developed a side-viewing videoduodenoscope with a 8.0-mm outside diameter of the tip and a 2.0-mm diameter instrument channel (Olympus PJF-240). In a total of 10 pediatric patients aged 11 months to 15 years (mean age, 6.1 years) who underwent ERCP using this videoduodenoscope, its feasibility was evaluated. Clinical diagnoses included pancreatitis (n = 4), choledochal cyst (n = 3), sclerosing cholangitis (n = 1), cholecystitis (n = 1), and choledocholithiasis (n = 1). In all patients, ERCP was done in the standard fashion under general anesthesia. ERCP was successful in 9 of 10 patients (90%). In the procedure, entering the descending duodenum was smooth and positioning the papilla on the endoscopic image was proper. In an 11-month-old infant, extraction of biliary stones by endoscopic balloon dilation was successfully done. Post-ERCP complications, including a significant increase of serum amylase levels, were not reported in any patients. This new videoduodenoscope has a potential for ERCP in all age groups of children.