Ding Sheng, Zeng Jing-Qing, Deng Zhao-Hui, Zhang Tian-Ao, Gong Biao
Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
Department of Digestive Diseases, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
BMC Pediatr. 2025 Aug 28;25(1):660. doi: 10.1186/s12887-025-06047-z.
The main treatments for biliary dilatation (BD) are surgical resection and choledochojejunostomy. However, various factors lead to the postponement of early surgical intervention in pediatric BD patients. This study aimed to analyze the effectiveness and limitations of endoscopic retrograde cholangiopancreatography (ERCP) in BD pediatric patients.
Data on patients with BD treated at two centers from June 2018 to June 2022 were retrospectively collected. Patients were categorized into five groups according to Todani classification. Clinical features, ERCP processes, ERCP-related complications, ERCP effectiveness and its limitations were reviewed.
A cohort of 77 symptomatic BD patients was evaluated, with pancreaticobiliary malformation (PBM) identified in 68.8% of cases. These patients underwent 142 hospitalizations, including 96 involving ERCP and 46 without ERCP. ERCP was performed in 74.0% (57/77) of BD patients, with a median follow-up of 26 months (range: 2-48 months), achieving an effectiveness rate of 75.4%. ERCP-related complications included post-ERCP pancreatitis (20.8%), postoperative infections (6.3%), and bleeding (2.1%). All complications were mild and managed conservatively. Further stratified analysis revealed that patients under 36 months of age at onset (P = 0.001) and those with elevated liver enzymes (P = 0.049) did not respond well to ERCP. The proportion of jaundice (P = 0.006) and biliary obstruction (P = 0.013) was significantly higher in the group with an onset age of ≤ 36 months compared to the group with an onset age > 36 months.
ERCP is suitable for BD pediatric patients with mild and acceptable complications. Careful consideration is required when deciding to perform the procedure, as therapeutic outcomes are limited in patients with an onset age under 36 months.
胆管扩张（BD）的主要治疗方法是手术切除和胆肠吻合术。然而，多种因素导致小儿BD患者早期手术干预延迟。本研究旨在分析内镜逆行胰胆管造影（ERCP）在小儿BD患者中的有效性和局限性。
回顾性收集2018年6月至2022年6月在两个中心接受治疗的BD患者的数据。根据Todani分类将患者分为五组。对临床特征、ERCP操作过程、ERCP相关并发症、ERCP有效性及其局限性进行了回顾。
评估了77例有症状的BD患者队列，68.8%的病例诊断为胰胆管畸形（PBM）。这些患者共住院142次，其中96次涉及ERCP，46次未进行ERCP。74.0%（57/77）的BD患者接受了ERCP，中位随访时间为26个月（范围：2 - 48个月），有效率为75.4%。ERCP相关并发症包括ERCP术后胰腺炎（20.8%）、术后感染（6.3%）和出血（2.1%）。所有并发症均为轻度，采用保守治疗。进一步分层分析显示，发病年龄在36个月以下的患者（P = 0.001）和肝酶升高的患者（P = 0.049）对ERCP反应不佳。发病年龄≤36个月的组与发病年龄>36个月的组相比，黄疸（P = 0.006）和胆管梗阻（P = 0.013）的比例显著更高。
ERCP适用于并发症轻微且可接受的小儿BD患者。决定进行该手术时需要仔细考虑，因为发病年龄在36个月以下的患者治疗效果有限。
