Abstract
The advantages of performing ERCP in patients with pancreaticobiliary maljunction (PBM) or congenital biliary dilatation (CBD) lie in the clear depiction of the pancreaticobiliary junction, precise understanding of the dynamic function of the sphincter muscle, bile collection or biopsy if needed, and possible transition from the diagnostic to therapeutic approach. On the other hand, the drawbacks include its invasiveness, causing incidental pancreatitis, infection and perforation, radiation exposure, and cardiorespiratory morbidity associated with deep sedation and general anesthesia. The choice of including ERCP in the diagnostic workup greatly depends on the age of patients, along with consideration of the likelihood of occurrence of biliary carcinoma, diagnostic value of other imaging modalities, vulnerability to the invasiveness of ERCP, requirement of endoscopic therapeutic measures, and the need for sedation or general anesthesia during ERCP. Experienced endoscopists can satisfactorily perform both pediatric and adult ERCP with excellent visualization rates of the pancreaticobiliary junction, along with almost little major adverse events. However, since the combination of MRCP and intraoperative cholangiopancreatography (IOCP) can achieve superior visualization rates of the intrahepatic bile duct (IHBD) and determination of the subtype of common bile duct, and comparable results as ERCP for PBM in pediatric subjects, the indications for preoperative ERCP should be carefully considered, especially in small children.
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Abbreviations
- CBD:
-
Congenital biliary dilatation
- DIC-CT:
-
Drip infusion cholangiography with computed tomography
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
- HCPBD:
-
High confluence of pancreaticobiliary ducts
- IHBD:
-
Intrahepatic bile duct
- IOCP:
-
Intraoperative cholangiopancreatography
- MRCP:
-
Magnetic resonance cholangiopancreatography
- PD:
-
Pancreatic duct
- PBM:
-
Pancreaticobiliary maljunction
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Saito, T., Yoshida, H. (2018). Significance of ERCP for the Diagnosis and Treatment of Pancreaticobiliary Maljunction and Congenital Biliary Dilatation. In: Kamisawa, T., Ando, H. (eds) Pancreaticobiliary Maljunction and Congenital Biliary Dilatation. Springer, Singapore. https://doi.org/10.1007/978-981-10-8654-0_13
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