title: Utility of ERCP in neonatal and infant cholestasis.
abstract: OBJECTIVE
  In neonates and infants with biliary obstruction, the diagnosis is important to establish early. Despite the use of several noninvasive imaging modalities, a definite diagnosis of biliary atresia (BA) or other pancreaticobiliary disorders may be difficult to ascertain. In this paper, we report our experience with endoscopic retrograde cholangiopancreaticography (ERCP) in the clinical situation of neonatal and infant jaundice.
  
  
  METHODS
  Between 1999 and 2006, we performed 23 ERCP procedures in 22 neonates and infants with the provisional diagnosis of biliary obstruction where other imaging was inconclusive. The mean age was 2.4 months and the mean weight was 4.8 kg. A pediatric videoendoscope with an outer diameter of 7.5 mm was used in all patients.
  
  
  RESULTS
  ERCP was successful in 20 of 23 patients. BA was suggested in 6 patients, all subsequently verified by surgery. Detailed visualization of biliary structures important for planning of treatment was performed in children with choledochal cysts and spontaneous biliary perforation. Cannulation of the ampulla failed in 3 patients, of whom 1 had BA, 1 a choledochal stone, and 1 bile plug syndrome. Only 1 therapeutic ERCP was performed in a child with a stone completely obstructing the ampulla. The only complications were 1 asymptomatic case of hyperamylasemia and 1 of mild cholangitis successfully treated with antibiotics.
  
  
  CONCLUSIONS
  ERCP is feasible and safe in the workup of neonatal cholestasis where other imaging modalities are inconclusive. Despite the expanding role of magnetic resonance cholangiography, ERCP may still have a role in the multidisciplinary workup of these patients.
authors.affiliation: Department of Medicine, Rikshospitalet University Hospital, Oslo, Norway. larsaa@medisin.uio.no
authors.forename: Lars
authors.initials: L
authors.lastname: Aabakken
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Aagenaes
authors.forename: Truls
authors.initials: T
authors.lastname: Sanengen
authors.forename: Steinar
authors.initials: S
authors.lastname: Aasen
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Emblem
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjornland
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D020698:Duodenoscopes; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome