Efficacy of ERCP via the accessory papilla in children with choledochal cysts.
BACKGROUND
ERCP via the major duodenal papilla in children with choledochal cyst may not clearly visualize the entire pancreatic duct and the junction of the pancreatic and biliary ducts. This may be caused by obstruction of the pancreatic duct by a dilated common bile duct.


METHODS
Patients with choledochal cysts who underwent ERCP with injection of contrast medium at the major duodenal papilla were classified as either belonging to a MP group, in which the entire pancreatic duct and junction of the pancreatic and biliary ducts were visualized, or to a M/AP group, in which these structures were either partially visualized or not visualized. ERCP via the accessory papilla subsequently was performed in the M/AP group by using 0.6- or 0.8-mm metal-tip catheters. The efficacy of ERCP via the accessory papilla in children with choledochal cysts was evaluated.


METHODS
ERCP was performed in 13 patients. Seven were assigned to the MP group and 6 to the M/AP group. ERCP via the accessory papilla in the M/AP group was successful in 5 of the 6 patients; pancreas divisum was demonstrated in one, a protein plug at the main pancreatic duct in another, and the entire pancreatic duct and junction of the pancreatic and biliary ducts in the remaining 3 patients. No patient developed pancreatitis as a result of ERCP, including ERCP via the accessory papilla.


CONCLUSIONS
In children with choledochal cyst, ERCP via the accessory papilla is an effective method for visualization of the detailed structure of the entire pancreatic ductal system and junction of the pancreatic and biliary ducts when ERCP via the major duodenal papilla is unsuccessful.
Kouchi
Katsunori
K
Department of Pediatric Surgery, School of Medicine, Chiba University, Chiba, Japan.
Yoshida
Hideo
H
Matsunaga
Tadashi
T
Kuroda
Hiroaki
H
Hishiki
Tomoro
T
Saito
Takeshi
T
Matsuura
Gen
G
Komatsu
Shugo
S
Ohnuma
Naomi
N
D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery; D016896:Treatment Outcome