Abstract
33 Pancreaticobiliary disease is increasingly recognized in pediatric patients. Increased awareness and technological advances permit the evaluation of the pancreaticobiliary system in small children. We present our combined experience in diagnostic and therapeutic ERCP over the last 6 years. Methods. A retrospective review of the records showed that since 1992 a total of 102 ERCP were performed on 85 patients at The Children's Hospital Memorial Medical Center and the Mayo Clinic and Foundation. Of these 33 were therapeutic interventions performed on 22 patients. The instruments used were the diagnostic and therapeutic duodenoscopes (Olympus Corporation, Arlington Height, IL). All therapeutic procedures were performed with the assistance of an experienced adult endoscopist. Results. There were 7 boys and 15 girls. Sphincterotomy with stent placement was performed for recurrent acute pancreatitis with pancreas divisum in 3 patients; in 1 for pseudocyst drainage with chronic recurrent pancreatitis; and for proximal stricture in 2 patients. Sphincterotomy with stone extraction in 8 patients. Stent placement for traumatic injury to the bile duct in 2 patients. Stent placement for extrinsic obstruction of the common bile duct in 1 patients. Sphincterotomy for relief of cholestasis and pruritus in 3 patients with HIV cholangiography and stage III AIDS. Balloon dilatation for CBD stricture in 3 patients. The results of the procedure were successful in all patients except three: two with recurrent acute pancreatitis that eventually required surgical drainage and one with persistent CBD stricture requiring choledochojejunostomy. There was one case of pancreatitis post ERCP requiring hospital admission. One patient dies of unrelated complications after small bowel transplantation for intestinal pseudo-obstruction (Pancreas divisum). Conclusion. Therapeutic ERCP is an acceptable modality for children with pancreaticobiliary disease in close collaboration with experienced adult endoscopists.
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