Abstract
Over a twenty-year period, we performed 255 ERCP procedures in infants aged up to 1 year. ERCP was indicated in cholestatic infants with suspicion of biliary obstruction. The most common diagnosis was biliary atresia (48%), choledochal cysts (13%), and choledocholithiasis (4%). The procedure complication rate was 13.7%. Hyperamylasemia occurred in 12.9%. More severe complications were rare‐0.8% of ERCP procedure. There were no cases of postprocedural pancreatitis or death. Our study has proved that ERCP is a safe and reliable method in this age group. Its high specificity and negative predictive value for extrahepatic biliary atresia can prevent unnecessary surgeries in patients with normal bile ducts or endoscopically treatable pathologies.
Highlights
Cholestasis in children under one year is a serious condition with multiple etiologies
Newborns are indicated mainly for neonatal cholestasis with the goal to exclude or confirm biliary atresia. e unnecessary surgery can be avoided if ERCP fading confirms a normal biliary tract
ERCP was indicated in a subgroup of cholestatic infants with a suspicion of extrahepatic biliary obstruction. e standardized algorithm of diagnostic workup adopted at our institution was used (Figure 1)
Summary
Cholestasis in children under one year is a serious condition with multiple etiologies. ERCP is one of the diagnostic and potentially therapeutic methods that can distinguish between a surgical and a nonsurgical etiology of cholestasis. Indications for ERCP differ in various age groups. In the group of children aged less than 1 year, ERCP is a useful method of confirming or excluding biliary atresia and pancreaticobiliary maljunction. Newborns are indicated mainly for neonatal cholestasis with the goal to exclude or confirm biliary atresia. E second most frequent indication is suspicion of a choledochal cyst in patients with obstructive jaundice. In these cases, there is a relatively small dilatation of the bile duct, with plugs stemming from protein debris from the wall of the bile duct. Insertion of a biliary stent can postpone the necessity of surgery at an older age
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