Document Detail

Diagnostic efficacy of ERCP in cholestatic infants and neonates--a retrospective study on a large series.
MedLine Citation:
PMID:  20140829     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND STUDY AIMS: Cholestatic jaundice in infants is a serious condition, requiring timely and accurate diagnostic evaluation. Our aim was to determine the safety and diagnostic efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of cholestatic liver disease in neonates and infants. PATIENTS AND METHODS: ERCP procedures in cholestatic infants performed in our endoscopy unit between December 1998 and March 2008 were reviewed retrospectively (n = 104 children, 48 boys, 56 girls; mean age 7 weeks, range 3 - 25 weeks; mean weight 4.05 kg, range 1.5 - 4.8 kg). Endoscopic findings were compared with final diagnoses. Statistical analysis was performed and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of ERCP were calculated both separately for each diagnosis and on aggregate. RESULTS: Cannulation of the papilla was successful in 95 of 104 patients (success rate 91.3 %). Biliary atresia of any type was found in 51 children (53.7 %), with a sensitivity of 86 %, a specificity of 94 %, a PPV of 96 %, and a NPV of 100 %. Choledochal cysts were found in seven children (7.4 %), with a sensitivity of 100 %, a specificity of 90 %, PPV of 86 %, and NPV of 100 %. Biliary stones were found in seven patients (7.4 %). Other structural pathology was found in six patients, and no abnormality was seen in 24 patients. No severe complications occurred during or after ERCP. CONCLUSIONS: ERCP in cholestatic infants, when performed in an expert center, is a safe and reliable procedure that can detect biliary tract abnormalities (e. g. biliary atresia, bile duct stones or choledochal cysts) with high sensitivity and specificity. Laparotomies can be prevented in infants by demonstrating normal patency of the biliary tract by ERCP or by magnetic resonance cholangiography if improvements in this technique are made.
R Keil; J Snajdauf; M Rygl; K Pycha; R Kotalov?; J Dr?bek; J Stov?cek; M Procke
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-02-05
Journal Detail:
Title:  Endoscopy     Volume:  42     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-08     Completed Date:  2010-06-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  121-6     Citation Subset:  IM    
Copyright Information:
(c) Georg Thieme Verlag KG Stuttgart . New York.
Department of Internal Medicine, Charles University, 2nd Medical School, Motol University Hospital, Prague, Czech Republic.
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde / methods,  standards*
Cholestasis / diagnosis*
Diagnosis, Differential
Follow-Up Studies
Infant, Newborn
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity

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