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Endoscopic biliary drainage management for children with serious cholangitis caused by congenital biliary dilatation

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Abstract

Congenital biliary dilatation (CBD) is usually associated with complications such as recurrent cholangitis, manifested as abdominal pain, vomiting, and jaundice. If cholangitis cannot be controlled by conservative treatment, a good therapeutic effect can be obtained through percutaneous biliary drainage or open T-tube drainage. We aimed to evaluate our experiences in biliary drainage through endoscopic retrograde cholangiopancreatography in children with cholangitis caused by CBD. From January 2014 to December 2017, 167 children with CBD were treated in our hospital. 17 patients (10.18%) with serious cholangitis caused by CBD underwent ERCP. There were 4 males and 13 females with an age range of 10–120 months (average 56.4 months). Placement of a biliary stent was attempted for biliary drainage through endoscopic retrograde cholangiopancreatography. Of the 17 patients studied, 13 children had jaundice and 15 had elevated aminotransferases. ERCP showed CBD in all patients and a common biliopancreatic duct in 12 of 17 patients (70.6%). Five patients underwent nasobiliary drainage and 12 patients underwent biliary drainage through double pigtail tubes. All patients achieved successful biliary drainage. Postoperative pancreatitis occurred in one patient. Biochemical indicators decreased significantly in 12 patients (70.6%) on the second postoperative day. The average length of hospital stay after surgery was 4.5 (range 3–7) days. No major complications related to ERCP were observed and all children had a good prognosis so far. Endoscopic biliary drainage is a safe, simple, and reliable technique. It can be used to resolve CBD-associated cholangitis, evaluate the biliary tract and pancreatobiliary duct junction, and guide pediatric surgeons to choose the right time and the correct procedure for CBD.

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Authors and Affiliations

  1. Department of General Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Bin Sun, DongHai Yu, Ji Chen & YongHui Tang

  2. Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, 210008, China

    Han Wu

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  1. Bin Sun
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  2. DongHai Yu
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  3. Ji Chen
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  4. YongHui Tang
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  5. Han Wu
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Contributions

JC and DY wrote the main body of the article under the supervision of BS. HW provided advice on medical aspects. All authors contributed to the design and interpretation of the study and further drafts. Bin Sun is the guarantor.

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Correspondence to Bin Sun.

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All the authors (Bin Sun, DongHai Yu, Ji Chen, YongHui Tang, Han Wu) declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sun, B., Yu, D., Chen, J. et al. Endoscopic biliary drainage management for children with serious cholangitis caused by congenital biliary dilatation. Pediatr Surg Int 34, 897–901 (2018). https://doi.org/10.1007/s00383-018-4296-3

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  • DOI: https://doi.org/10.1007/s00383-018-4296-3

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