The role of endoscopic retrograde cholangiopancreatography in infants withcholestasis

Background/Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) w as assessed in the diagnosis of cholestatic liver disease in infants. Methods: ERCP was performed in 50 infants who had prolonged cholestasis. Th eir ages ranged from 25 to 274 days (mean, 69 days), and their weight range d from 2.6 to 6.7 kg (mean, 4.7 kg). Incomplete visualization of the biliar y tree or visualization of only the pancreatic duct was followed by explora tory laparotomy. In those in whom the biliary tree was visualized completel y, the caliber of the bile duct was compared with that of the pancreatic du ct. Results: ERCP was completed in 43 patients (success rate, 86%) without comp lications. In the 7 patients in whom ERCP failed, 6 had biliary atresia (BA ) diagnosed by exploratory laparotomy. The other patient had congenital bil iary dilatation (CBD), In 29 of the 43 patients, the biliary tree was seen partially or only the pancreatic duct was visualized. These patients had BA diagnosed by laparotomy. Complete visualization of the biliary tree was ob tained in 14 patients. Of these, 9 had neonatal hepatitis (NH), 2 had a pau city of intrahepatic bile ducts (PIBLD), and 3 had CBD. In all of the patie nts with NH, cholestasis improved spontaneously. The 2 patients with PIBLD had biopsy-proven disease. The caliber of the bile duct was larger than tha t of the pancreatic duct in NH. This relationship was not observed in PIBLD , Conclusions: ERCP is safe in infants. It is useful in the diagnosis of prol onged cholestasis. Copyright (C) 2000 by W.B. Saunders Company.