Sequential Endoscopic/Laparoscopic Management of Sickle Hemoglobinopathy-Associated Cholelithiasis and Suspected Choledocholithiasis

Cf, Gholson; Jf, Grier; Mb, Ibach; Favrot, Dana; Nall, L; Sittig, Kevin; Jc, McDonald

doi:10.1097/00007611-199511000-00009

Cited by 16 publications

(10 citation statements)

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“…Like others, we found ERCP to be useful both in the diagnosis and management of CBD stones prior to LC. 13,14 A 97% cannulation success rate in our series is similar to the experience of others. [15][16][17] Although pediatric duodenoscopes are now available, ERCP was performed in our patients without difficulty, using the adult-size viewing duodenoscope under sedation, except in those children aged 10 years or younger, where this was done under general anesthesia to protect against airway compression.…”

Section: Discussionsupporting

confidence: 90%

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The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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The role of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of biliary and pancreatic diseases is well established in adults.1 This, however, is not the case in the pediatric age group, because biliary and pancreatic diseases are less common in children. In addition to this problem is the lack of pediatric gastroenterologists who are skilled in performing ERCP in children. Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. 3-5The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy. Patients and MethodsOver a four-year period from September 1993 to August 1997, 34 consecutive children less than 18 years old had ERCP as part of their management at our hospital. The records of these patients were reviewed retrospectively for age, gender, indication for ERCP, pre-ERCP investigations, results, complications of ERCP and post-ERCP management.Informed, written consent for ERCP was obtained from the child's parent. All ERCPs were performed in the Radiology Department. For patients 10 years old and below, ERCP was performed under general anesthesia with nasotracheal intubation. In those older than 10 years, ERCP was done under sedation only. Patients with sickle cell disease were hydrated with intravenous fluids starting the night before the procedure, at a rate of 1½ their maintenance requirements, and blood transfusions were given when necessary to increase their Hb to 10-12 g/dL. With the patients properly sedated, using meperedine (1 mg/kg) and diazepam (0.1-0.2 mg/kg), the Olympus JF1 T20 side-viewing duodenoscope was used in all the patients. After visualization, the ampulla of Vater was cannulated with tapered catheters and the pancreatic and biliary ducts were visualized by fluoroscopy during injection of Hexabrix (320 mg was diluted to 50%). Appropriate radiographs were obtained in all cases. Where indicated, sphincterotomy was performed using 5F sphincterotome (Olympus). Common bile duct stone extraction was performed with basket and balloon catheters. During the procedure, all patients were monitored with pulse oximetry with a cardiorespiratory trolley at the bedside. ResultsThe 34 children who had ERCP at Qatif Central Hospital as part of their management over the four-year study period comprised 20 males and 14 females. Their ages ranged from 5-18 years (mean 14.5 years). Of the 34 patients, 29 (85.3%) had sickle cell disease (SCD). Their mean HbS level was 77.8% (range 66.1-90.7) and their mean HbF level was 21% (range 7.2-37). The indications for ERCP are shown in Table 1. Obstructive jaundice was the most common i...

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Section: Discussionsupporting

confidence: 90%

“…This combined endoscopic sphincterotomy and stone extraction followed by LC has been reported in adults, 18,19 and recently in patients with SCD. 14 We found ERCP valuable in the diagnosis and management of CBD stones prior to LC. Eleven of our patients with CBD stones had successful ERCP and stone extraction prior to LC.…”

Section: Discussionmentioning

confidence: 84%

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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“…This, practice is also recommended by other authors [7,19], with the aim of avoiding CBD exploration since the duct is generally small in caliber. Our decision to perform postoperative ERCP, was based in part on the availability of expert surgical endoscopists in our department.…”

Section: Discussionmentioning

confidence: 95%

“…Most authors emphasize the importance of evaluating the CBD because of the high incidence of cho!edocholithiasis (--<30%) in patients with SCD and cholelithiasis [7]. However, among patients with SCD, the diagnosis of CBD stones is difficult.…”

Section: Discussionmentioning

confidence: 99%