Endoscopic Therapy for Patients With Pancreaticobiliary Maljunction: A Follow-up Study

Zheng, Jin; Gong, Bo

doi:10.1016/j.cgh.2016.09.090

Cited by 2 publications

(5 citation statements)

References 17 publications

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“…We found that it was also effective for children, as 83.3% of children with AnnP improved after the first endoscopic treatment in the present study. Children with PBM had the best results after endoscopic treatment, with an overall improvement rate of 88.9%, which was slightly higher that reported previously (60.7%–82.4%); 28,32 however, considering the risk of cholangiocarcinoma in PBM, radical surgery is recommended 33 . Nevertheless, some children face more risks during surgery due to their young age and poor nutritional status.…”

Section: Discussionmentioning

confidence: 76%

Clinical characteristics and endoscopic treatment of pancreatitis caused by pancreaticobiliary malformation in Chinese children

Zhang

Deng

Gong

2022

J of Digest Diseases

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Objectives We aimed to describe the clinical characteristics of pediatric patients with pancreatitis caused by pancreaticobiliary malformation and to evaluate the efficacy and safety of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of the disease. Methods Medical records of pediatric patients with pancreatitis related to pancreaticobiliary malformation diagnosed by ERCP and treated in our hospital between April 2008 and December 2020 were retrospectively reviewed. Clinical manifestations, laboratory indicators, genetic testing results and imaging findings including MRCP were collected. Results Of the 148 patients with pancreaticobiliary malformation‐related pancreatitis, 90 (60.8%) had pancreaticobiliary maljunction (PBM), 52 (35.1%) had pancreatic divisum (PD), and six (4.1%) had annular pancreas (AnnP). Compared with the PD group, patients with PBM were younger (P < 0.001), and were more likely to have jaundice (P < 0.001) and fever (P = 0.034). Genetic mutation was found in 51.6% of patients with PD, 50.0% with AnnP, and 15.0% with PBM. Diagnostic rate of PBM, PD, and AnnP using MRCP was 46.7%, 15.4%, and 100%, respectively. In total, 87.8% of patients had symptomatic improvement after endoscopic treatment. ERCP‐related complications were observed in 28 out of the 260 procedures, including post‐ERCP pancreatitis (7.7%), infection (2.3%), and gastrointestinal bleeding (0.8%). Conclusions PBM should be considered when jaundice and fever occur in pediatric patients. Genetic testing is recommended for those with PD and AnnP. The role of MRCP is limited in identifying pancreaticobiliary malformation in children. ERCP is effective and safe for the diagnosis and treatment for pediatric pancreatitis caused by pancreaticobiliary malformation.

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Section: Discussionmentioning

confidence: 76%

Clinical characteristics and endoscopic treatment of pancreatitis caused by pancreaticobiliary malformation in Chinese children

Zhang

Deng

Gong

2022

J of Digest Diseases

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“…ERCP can not only relieve these obstructions and provide better outflow by means of a sphincterotomy but can also image the pancreaticobiliary system to provide the needed information for surgical planning. 35,36 A recent article states that extrahepatic bile duct resection is the standard surgery for congenital biliary dilatation. 37 However, complete excision of the intrapancreatic bile duct and removal of stenotic hepatic ducts are necessary to prevent serious complications, including recurrent cancer after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…38 Endoscopic biliary sphincterotomy appears to be a logical step in the management of most symptomatic patients with a Type Ic CC. 2,35,36,38 With regard to the other pancreaticobiliary anomalies, most variations in the anatomy of the biliary tree appear to result from alterations in the budding from the foregut of the embryonic biliary tract. Minor anomalies usually cause no clinical problems but may be of great relevance to the biliary surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…The cause of acute pain and pancreatitis in this patient population is thought to be due to protein plugs in the common channel. ERCP can not only relieve these obstructions and provide better outflow by means of a sphincterotomy but can also image the pancreaticobiliary system to provide the needed information for surgical planning 35,36 . A recent article states that extrahepatic bile duct resection is the standard surgery for congenital biliary dilatation 37 .…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic sphincterotomy is recommended for sphincter of Oddi stenosis 38 . Endoscopic biliary sphincterotomy appears to be a logical step in the management of most symptomatic patients with a Type Ic CC 2,35,36,38 …”

Section: Discussionmentioning

confidence: 99%

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Congenital pancreaticobiliary anomalies in an urban medical center in the United States

et al. 2020

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Background and Aim Pancreaticobiliary anomalies are rare and often present with cryptic signs and symptoms, thus delaying appropriate treatment. Methods Endoscopic retrograde cholangiopancreatography (ERCP) was used to define pancreaticobiliary anomalies. A retrospective review was performed of 5522 ERCPs conducted at a tertiary care center from 1972 to 2015. Results There were 249 (4.5%) patients with pancreaticobiliary anomalies, including 179 patients with pancreas divisum (PD), 44 patients with choledochal cyst (CC) (Todani's classification Type I: extrahepatic cyst 31, Type III; choledochocele 9, Type V: Caroli's disease 4), 20 patients with anomalous pancreaticobiliary ductal union (APDU), and 6 patients with other abnormalities. Of 179 patients with pancreas divisum, 8 (4.5%) required minor sphincterotomies for multiple unexplained acute pancreatitis. Of the 31, 15 (48%) Type I CC patients underwent an operation. In patients with Type III CC (choledochocele), seven of the nine were treated by endoscopic sphincterotomy, and two patients were treated by surgery. Four patients with Type V CC (Caroli's disease) were managed nonoperatively. Of the 20 patients with APDU, 8 (40%) required operative intervention. Six patients were found to have other anomalies: two with pancreas bifidum, one with a duplication of the gallbladder, one with a cystic duct diverticulum, one with an annular pancreas, and one with an abnormal cystic duct origin. These patients were treated based on their etiology. Conclusion Pancreaticobiliary anomalies are rare and can be defined using ERCP. The appreciation of these abnormalities is important for the proper diagnosis and treatment of these rare biliary and pancreatic disorders.

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Endoscopic Therapy for Patients With Pancreaticobiliary Maljunction: A Follow-up Study

Cited by 2 publications

References 17 publications

Clinical characteristics and endoscopic treatment of pancreatitis caused by pancreaticobiliary malformation in Chinese children

Clinical characteristics and endoscopic treatment of pancreatitis caused by pancreaticobiliary malformation in Chinese children

Congenital pancreaticobiliary anomalies in an urban medical center in the United States

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