Endoscopic Retrograde Cholangiopancreatography (ERCP) in Biliary Tract Disease of
Infants Less than One Year Old
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NAOMI OHNUMA, HIDEYO
TAKAHASHI, MASAHIRO TANABE,
HIDEO YOSHIDA and JUN
IWAI
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Department of Pediatric Surgery, Chiba University, School of Medicine, Chiba 260
We performed a total of 75 examinations with endoscopic retrograde
chlangiopancreatography (ERCP) in 73 infants aged from 8 days to 300 days (mean 71 days)
between 1977 and 1995. ERCP examination was performed with a prototype duodenoscope
and was successful in 47 of 52 examinations in biliary atresia, 9 of 11 in neonatal hepatitis,
all 4 in paucity of intra-hepatic bile duct, 4 of 5 in congenital biliary dilatation, 1 of 2 in
duodenal stricture, and 1 case of in postoperative jaundice of hepatoblastoma. In 46 infants
with biliary atresia, excluding one in whom the findings could not be evaluated due to poor
x-ray image quality, we distinguished the following four patterns of ERCP findings: Pattern
1, only the pancreatic duct could be demonstrated and no bile duct was visualized (76%);
Pattern 2, only a part of the distal common bile duct with the pancreatic duct was visualized
(2%); Pattern 3, the entire length of the common bile duct with the pancreatic duct was
visualized without the gallbladder and the common hepatic duct (4%); and Pattern 4, the
common bile duct and the gallbladder with the pancreatic duct were visualized without the
common hepatic duct (18%). In all of these 46 patients, laparotomy, an operative
cholangiogram, and histological evaluation of the biliary duct were performed. In 9 neonates
with neonatal hepatitis, the biliary tract was opacified and biliary atresia was excluded.
Laparotomy was thus avoided in these neonates. There was no complication caused by either
ERCP or by anesthesia.
Key word(s)---
ERCP in infant; biliary atresia; infantile cholestasis; common channel of biliary atresia
Tohoku J. Exp. Med., 1997, 181, 67-74
Address for reprints:
Naomi Ohnuma, M.D., Department of Pediatric Surgery, Chiba University, School of
Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260, Japan.
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