Diagnosis and treatment value of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary disease

doi:10.3877/cma.j.issn.1673-5250.2026.03.006

Objective

To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with pancreaticobiliary diseases.

Methods

From May 2014 to April 2025, a total of 128 children with pancreatobiliary diseases who underwent ERCP at West China Hospital, Sichuan University, were retrospectively enrolled into this study. Among them, 59 were boys and 69 were girls. According to age, the patients were divided into four groups: toddler group (n=12, 1-3 years old), preschool group (n=24, 4-6 years old), school-age group (n=54, 7-12 years old), and adolescent group (n=38, 13-14 years old). The preoperative disease spectrum, indications for ERCP, procedural success rate, diagnostic and therapeutic outcomes, and postoperative complications were retrospectively analyzed among different age groups. This study was approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University [Approval No. 2025 Review (1621)]. Written informed consent for ERCP was obtained from the legal guardians or authorized representatives of all children.

Results

①Among the 128 children, 70 were preoperatively diagnosed with biliary diseases and 58 with pancreatic diseases. A total of 154 ERCP procedures were performed, of which 132 were successful, with an overall procedural success rate of 85.7% (132/154). Among the successful procedures, 129 were therapeutic ERCP, accounting for 97.7% (129/132). The preschool group had the highest procedural success rate (96.4%, 27/28). ② The main indications for ERCP were bile duct stones (36.7%, 47/128), chronic pancreatitis (21.1%, 27/128), and acute pancreatitis caused by pancreaticobiliary duct obstruction (19.5%, 25/128). Among the 70 children preoperatively diagnosed with biliary diseases, 80 ERCP procedures were performed, with a biliary cannulation success rate of 95.0% (76/80) and a procedural success rate of 91.3% (73/80). Among the 58 children preoperatively diagnosed with pancreatic diseases, 74 ERCP procedures were performed, with a pancreatic duct cannulation success rate of 94.6% (70/74) and a procedural success rate of 79.7% (59/74). In addition, congenital pancreaticobiliary duct anomalies were confirmed by ERCP in some children, including congenital choledochal cysts in 7 cases, pancreaticobiliary maljunction in 9 cases, and pancreas divisum in 2 cases. After ERCP treatment, bile duct stones and pancreatic duct stones were successfully removed, pancreaticobiliary duct obstruction was relieved, and related clinical symptoms were alleviated. Among the 154 ERCP procedures, postoperative complications occurred in 10 procedures, with an overall complication rate of 6.5% (10/154). Post-ERCP pancreatitis (PEP) was the most common complication, occurring in 8 procedures, with an incidence of 5.2% (8/154). Biliary tract infection and stent dislodgement each occurred in 1 procedure, with an incidence of 0.6% (1/154). No bleeding, perforation, or procedure-related mortality was observed.

Conclusions

ERCP showed favorable efficacy and safety in the diagnosis and treatment of pediatric pancreatobiliary diseases and may serve as an important minimally invasive diagnostic and therapeutic approach for these diseases in children.

Key words: Cholangiopancreatography, endoscopic retrograde, Biliary tract diseases, Pancreatic diseases, Choledocholithiasis, Pancreatitis, Safety, Treatment outcome, Child

表1 本研究不同年龄组患儿术前被拟诊的胆道疾病和胰腺疾病构成比比较[例数(%)]

组别	例数	胆道疾病	胰腺疾病
幼儿期组	12	9(75.0)	3(25.0)
学龄前期组	24	10(41.7)	14(58.3)
学龄期组	54	32(59.3)	22(40.7)
青春期组	38	19(50.0)	19(50.0)
合计	128	70(54.7)	58(45.3)

表1 本研究不同年龄组患儿术前被拟诊的胆道疾病和胰腺疾病构成比比较[例数(%)]

组别	例数	胆道疾病	胰腺疾病
幼儿期组	12	9(75.0)	3(25.0)
学龄前期组	24	10(41.7)	14(58.3)
学龄期组	54	32(59.3)	22(40.7)
青春期组	38	19(50.0)	19(50.0)
合计	128	70(54.7)	58(45.3)

表2 本研究21例胆胰疾病患儿22例次ERCP操作失败原因比较[例次(%)]

ERCP操作失败原因	发生率^a
胆管/胰管插管失败	8(5.2)
导丝/扩张导管无法通过胆管/胰管狭窄段	4(2.6)
导丝无法进入胰管远端	6(3.9)
胰管结石取石失败	1(0.6)
食管静脉曲张严重而停止进镜	1(0.6)
胆道闭锁术后无法找到胆肠吻合口	1(0.6)
患儿术中配合欠佳致未能成功置入胰管支架	1(0.6)

表2 本研究21例胆胰疾病患儿22例次ERCP操作失败原因比较[例次(%)]

ERCP操作失败原因	发生率^a
胆管/胰管插管失败	8(5.2)
导丝/扩张导管无法通过胆管/胰管狭窄段	4(2.6)
导丝无法进入胰管远端	6(3.9)
胰管结石取石失败	1(0.6)
食管静脉曲张严重而停止进镜	1(0.6)
胆道闭锁术后无法找到胆肠吻合口	1(0.6)
患儿术中配合欠佳致未能成功置入胰管支架	1(0.6)

表3 本研究4组胆胰疾病患儿ERCP操作例次及成功率比较

组别	例数	ERCP操作例次(次)	ERCP操作成功率[例次(%)]
幼儿期组	12	12	10(83.3)
学龄前期组	24	28	27(96.4)
学龄期组	54	66	55(83.3)
青春期组	38	48	40(83.3)
合计	128	154	132(85.7)

表3 本研究4组胆胰疾病患儿ERCP操作例次及成功率比较

组别	例数	ERCP操作例次(次)	ERCP操作成功率[例次(%)]
幼儿期组	12	12	10(83.3)
学龄前期组	24	28	27(96.4)
学龄期组	54	66	55(83.3)
青春期组	38	48	40(83.3)
合计	128	154	132(85.7)

表4 本研究4组胆胰疾病患儿ERCP适应证分布情况[例数(%)]

组别	例数	胆管结石	慢性胰腺炎	急性胰腺炎^a	梗阻性黄疸	CCC	其他^b
幼儿期组	12	5(41.7)	1(8.3)	2(16.7)	3(25.0)	1(8.3)	0(0)
学龄前期组	24	5(20.8)	6(25.0)	8(33.3)	3(12.5)	2(8.4)	0(0)
学龄期组	54	21(38.9)	13(24.1)	6(11.1)	9(16.6)	1(1.9)	4(7.4)
青春期组	38	16(42.1)	7(18.4)	9(23.7)	3(7.9)	0(0)	3(7.9)
合计	128	47(36.7)	27(21.1)	25(19.5)	18(14.1)	4(3.1)	7(5.5)

表4 本研究4组胆胰疾病患儿ERCP适应证分布情况[例数(%)]

组别	例数	胆管结石	慢性胰腺炎	急性胰腺炎^a	梗阻性黄疸	CCC	其他^b
幼儿期组	12	5(41.7)	1(8.3)	2(16.7)	3(25.0)	1(8.3)	0(0)
学龄前期组	24	5(20.8)	6(25.0)	8(33.3)	3(12.5)	2(8.4)	0(0)
学龄期组	54	21(38.9)	13(24.1)	6(11.1)	9(16.6)	1(1.9)	4(7.4)
青春期组	38	16(42.1)	7(18.4)	9(23.7)	3(7.9)	0(0)	3(7.9)
合计	128	47(36.7)	27(21.1)	25(19.5)	18(14.1)	4(3.1)	7(5.5)

图1 1例(女性，1岁)术前被拟诊为胆道疾病患儿ERCP取石过程照片图[图1A：腹部CT检查提示胆总管结石(红色箭头所示)；图1B：十二指肠乳头胆管插管；图1C：X射线透视下ERCP胆管造影；图1D：MRCP检查确诊胆总管结石(红色箭头所示)；图1E：ERCP操作下胆道取石；图1F：X射线透视下网篮取石]注：ERCP为内镜下逆行胰胆管造影术，MRCP为磁共振胰胆管成像

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