Diagnostic and Therapeutic ERCP in Children with Sickle Cell Disease

Abstract

ABSTRACT

Over a period of less than 3 years, diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was performed on 24 children with sickle cell disease (SCD) aged 8–18 years. The adult side-viewing duodenoscope was used. Intravenous sedation with diazepam and meperedine was used except in those children 10 years of age and younger, in whom general anesthesia was used. The indications for ERCP were obstructive jaundice in 18 patients, pancreatitis in 2, cholangitis in 2, recurrent biliary colic in 1, and postlaparoscopic cholecystectomy (LC) bile leak in 1. Cannulation of the ampulla of Vater was accomplished in all 24 patients (100%). ERCP provided valuable additional information in SCD patients with hepatobiliary and pancreatic diseases. Endoscopic sphincterotomy was successfully performed in 21 patients, 10 of whom had undergone extraction of common bile duct (CBD) stones endoscopically before LC. Nine other patients with CBD dilation and no stones underwent endoscopic sphincterotomy. In two of them, the papilla was enlarged, with an inflamed orifice suggestive of recent stone passage. Two other patients underwent endoscopic sphincterotomy and nasobiliary drainage: for papillary stenosis in one and for temporary relief of obstructive jaundice due to multiple giant CBD stones in the other. One patient underwent endoscopic mechanical lithotripsy of large CBD stones and stone extraction followed by LC. We conclude that ERCP is safe and useful in the diagnosis and treatment of children with SCD and pancreatobiliary disorders. This is especially true in the era of LC.