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Endoscopy 2010; 42(2): 121-126
DOI: 10.1055/s-0029-1215372
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic efficacy of ERCP in cholestatic infants and neonates – a retrospective study on a large series

R.  Keil1 , J.  Snajdauf2 , M.  Rygl2 , K.  Pycha2 , R.  Kotalová3 , J.  Drábek1 , J.  Stovícek1 , M.  Procke1
  • 1Department of Internal Medicine – Gastroenterology and Endoscopy, Charles University, 2nd Medical School, Motol University Hospital, Prague, Czech Republic
  • 2Department of Pediatric Surgery, Charles University, 2nd Medical School, Motol University Hospital, Prague, Czech Republic
  • 3Department of Pediatrics, Charles University, 2nd Medical School, Motol University Hospital, Prague, Czech Republic
Further Information

Publication History

submitted 28 January 2009

accepted after revision 29 September 2009

Publication Date:
05 February 2010 (online)

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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.

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M. ProckeMD 

Interni klinika UK 2. LF a FN Motol

V Uvalu 84
150 06 Praha 5
Czech Republic

Fax: +420-2-24433075

Email: michal.procke@fnmotol.cz

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