INTRODUCTION: Biliary cysts with an abnormal pancreatobiliary junction are one of the most common pancreatobiliary malformations. The main symptom is cholestasis; endoscopic retrograde cholangiopancreatography (ERCP) plays a key role in diagnosis. AIM: Retrospective evaluation of ERCP performed to diagnose abnormalities of the pancreatobiliary junction. MATERIAL AND METHODS: We retrospectively evaluated ERCP performed to diagnose abnormalities of the pancreatobiliary junction, mainly choledochal cysts, in 112 children between 1990 and 2011. RESULTS: We performed 112 examinations of 50 children with abnormal pancreatobiliary junction and choledochal cysts (15 males and 35 females, average age: 5 years, range: 1 month - 15 years). Cysts were associated with a common channel in 37 (74%) cases, were not associated with a common channel in 9 (18%) cases, and in 3 (6%) cases the common channel lacked cysts. We performed endoscopic papilla sphincterotomy on 33 (66%) patients; endoscopic drainage was performed 62 times, including 17 patients without papilla sphincterotomy. In 15 (30%) cases, we only performed sphincterotomy. Extraction of lithiasis was done in 2 (4%) cases. Both ERCP and magnetic resonance cholangiopancreatography (MRCP) were performed on 13 patients. There was concordance of the choledochal cyst and of the type of cyst in both methods; however, common channels could not be observed by MRCP. There was 1 serious complication (perforation after sphincterotomy) and 11 (9%) mild adverse events. CONCLUSIONS: When performed at an expert centre, ECRP is a safe and reliable procedure for children with choledochal cysts and/or an abnormal pancreatobiliary junction. Endoscopic retrograde cholangiopancreatography remains a reasonable alternative because MRCP has a limited ability to diagnose the precise anomalies of the pancreatobiliary junction and has no therapeutic capabilities.

Clinic of Internal Medicine University Hospital Motol Prague Czech Republic

Clinic of Paediatric Surgery University Hospital Motol Prague Czech Republic

Clinic of Paediatry University Hospital Motol Prague Czech Republic

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Singham J, Yoshida EM, Scudamore CH. Choledochal cysts, classification and pathogenesis. J Can Chir. 2009;52:434–8. PubMed PMC

Yamaoka K, Tazawa J, Koizumi K, et al. Choledochocele with obstructive jaundice: a case report and a review of the Japanese literature. J Gastroenterol. 1994;29:661–4. PubMed

ONeill JA., Jr Choledochal cysts. Curr Probl Surg. 1992;29:361–410. PubMed

Alonso-Lej F, Rever WB, Pessango DJ. Congenital choledochal cyst with a report of 2, and analysis of 94 cases. Int Abstr Surg. 1959;108:1–30. PubMed

Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts, classification, operative procedures and review of thirty-seven CASE including cancor arising from choledochal cyst. Am J Surg. 1977;134:263–9. PubMed

Babbit DP. Congenital choledochal cysts: new ethiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris) 1969;12:231–40. PubMed

Cheng SP, Yang TL, Jeng KS, et al. Choledochal cysts in adults: aetiological considerations to intrahepatic involvement. ANZ J Surg. 2004;74:964–7. PubMed

Yotsuynagy S. Contribution to aetiology and pathology of idiopathic cystic dilatation of the common bile duct with report of three cases. Gann. 1936;30:601–752.

Levy AD, Rohrman CA. Biliary cystic disease. Curr Probl Dian Radiol. 2003;32:233–63. PubMed

Fulcher AS, Turner MA, Sanyal AJ. Case 38: Caroli’s disease and renal tubular ectasia. Radiology. 2001;220:720–2. PubMed

Tsuchiya R, Harada N, Ito T, et al. Malignant tumors in choledochal cysts. Ann Surg. 1977;186:22–8. PubMed PMC

Lam WM, Lam TP, Saing H. MR cholangiography and CT cholangiography of pediatric patients with choledochal cysts. AJR Am Roentgenol. 1999;173:401–5. PubMed

Kim MJ, Han SJ, Yoon CS, et al. Cholangiopancreatography to reveal anomalous pancreatobiliary ductal union in infants and children with choledochal cysts. AJR Am J Roentgenol. 2002;179:209–14. PubMed

Arhanskiy Y, Vyas PK. Type IV. Choledochal cyst presenting with obstructive jaundice: role of MR cholangiopancreatography in preoperative evaluation. AJR Am J Roentgenol. 1998;171:457–8. PubMed

Pietrabissa A, Boggi U, Di Candio G, et al. Unsuspected choledochal cyst during laparostopic cholecystectomy. Surg Endosc. 1995;9:1127–9. PubMed

Keil R, Šnajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates – a retrospective study on large series. Endoscopy. 2010;42:121–6. PubMed

Park KB, Auh YH, Kim JH, et al. Diagnostic pitfails in the cholangiopancreatographic diagnosis of choledochoceles: cholangiographic duality and its effect on visualisation. Abdom Imaging. 2001;26:48–54. PubMed

Sawyer M. Imaging in choledochal cyst. Emedicine.medscape.com/article/366004-overview, Apr 12, 2011.

Norton KI, Glass RB, Kogan D, et al. MR cholangiography in the evaluation of neonatal cholestasis: initial results. Radiology. 2002;222:687–91. PubMed

Chavhan GB, Babyn PS, Manson D, et al. Cholangiography: principles, technique and clinical applications. Radiographics. 2008;28:1951–62. PubMed

Park DH, Kim M, Lee SK, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts ? Gastrointest Endosc. 2005;62:360–6. PubMed

Schaefer JF, Kirschner HJ, Lichy M, et al. Highly resolved free-breathing magnetic resonance cholangiopancreatography in the diagnostic workup of pancreatobiliary diseases in infants and young children – initial experiences. J Pediatr Surg. 2006;41:1645–51. PubMed

Guideline for the evaluation of cholestatic jaundice in infants: Recomendation of the North American Society for Pediatric Gastroenterology, Hematology and Nutrition. J Pediatr Gastroenterol Nutr. 2004;39:115–28. PubMed

Keil R, Šnajdauf J, Štuj J, et al. Endoscopic retrograde cholangiopancreatography in cholestatic infants – our experience. Endoscopy. 2003;35(Suppl II):A225.

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