ERCP in the Pediatric Population
Transcript of ERCP in the Pediatric Population
ERCP in the Pediatric Population
Ross Goshorn
M4
USC SOM - Radiology
Goals of this presentation
• Gain Basic Understanding of ERCP
• History of and Indications for ERCP in Pediatrics
• Exposure to ERCP Imaging
• Complications in Pediatrics
ERCP Basics
• What Does ERCP Stand for?– Endoscopic retrograde
cholangiopancreatography
• How is it Performed?– Anatomy review
ERCP in Pediatrics
• History and Indications for ERCP– History of ERCP for pediatrics
• Has reported use since the 1980’s
• Began with adult sized scope
• Used primarily for evaluation of neonatal cholestasis and suspected biliary tract abnormalities
• Originally instituted to help establish definitive diagnoses without need for laparoscopy/laparotomy
– Indications for procedure• Depends on your source
Indications for ERCP
• North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)– Evaluation of Neonatal Cholestasis– Recurrent Pancreatitis
• Other Resources – Congenital Biliary Tract Disorders– Acquired Bililary Tract Disorders
Neonatal Cholestasis
• Congenital (Neonatal Cholestasis)– Biliary Atresia
– Alagille Syndrome
– Caroli’s Disease
– Choledochal Cysts
– Biliary Strictures
• Acquired– Sclerosing Cholangitis
– Ascariasis
– Choledocholithiasis
– Bile Plug Syndrome
– Malignant Biliary Strictures
Biliary Atresia• Incidence
– occurs in approximately 1/10,000 - 20,000 births
• Pathophysiology– characterized by inflammation of the bile ducts leading to
progressive obliteration of the extrahepatic biliary tract
• Clinical Presentation– Newborn with persistently elevated conjugated bilirubin with
“clay colored” acholic stool
• Diagnosis– Ultrasound Scintigraphy Duodenal Aspirate– Liver Biopsy ERCP MRCP
ERCP Findings with Biliary Atresia
Type 1 - non visualization of the biliary tree
Type 2 - visualization of the distal common duct and the gallbladder
Type 3a - Visualization of the gallbladder and the complete common duct with biliary lakes at the porta hepatis
Pediatric ERCP Specifics
• The Scope - Pediatric duodenoscope used in neonates and infants < 12 mo
• The MD - Adult endoscopist or tertiary care facility performed in radiology suite
• The Pt - typically requires deep sedation if not general anesthesia
• Constraints – Time, contrast, fluoro, selective cannulation
Pediatric ERCP Specifics
• Complications– Less than 12 months
• Rates vary but range from 2.4-13%, complications mostly related to sedation, a few had duodenal erosions and one episode of abdominal distension.
– Greater than 12 months • Complications in 4.7 % of cases including fever,
and mild pancreatitis in pts with history of pancreatitis
Goals of this presentation
• Gain Basic Understanding of ERCP
• History of and Indications for ERCP in Pediatrics
• Exposure to ERCP Imaging
• Complications in Pediatrics
References
• Journal of Pediatric Gastroenterology and Nutrition 39:115-128 © Aug 2004 Lippincott Williams & Wilkins, Philadelphia
• Varadarajulu, et al. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004; 60:367
• UpToDate - “ERCP in children: Technique, success, and compliations,” “ERCP for biliary disease in children,” “Approach to neonatal cholestasis.”