title: Endoscopic biliary drainage for children with persistent or exacerbated symptoms of choledochal cysts.
abstract: BACKGROUND
  Symptoms of choledochal cysts sometimes persist or become exacerbated. As preoperative management for patients with these cysts, we prospectively employed endoscopic drainage, based on the theory that protein plugs cause symptoms by obstructing the pancreatobiliary ducts.
  
  
  METHODS
  Children with choledochal cysts underwent endoscopic retrograde cholangiopancreatography (ERCP). When ERCP showed compaction with filling defects in patients with persistent or worsening symptoms (study patients), the placement of a short biliary stent tube was attempted for drainage. The clinical and ERCP findings of the study patients were compared with those of patients who were asymptomatic at ERCP (asymptomatic patients).
  
  
  RESULTS
  There were 13 study patients (median age 2.9 years) and 41 asymptomatic patients (4.7 years) enrolled in the study between August 2005 and February 2011. Study patients more frequently had jaundice and elevated transaminase levels. ERCP showed that all study patients had obstruction or compacted filling defects in the common channel or the narrow segment distal to the cyst. Insertion of a stent tube was successful in 11 patients. Symptoms were relieved soon after biliary drainage. Surgery revealed that the obstructing materials were protein plugs, except in one case, which involved fatty acid calcium stones.
  
  
  CONCLUSIONS
  These results support the protein plug theory. Endoscopic short-tube stenting is adequate and effective as preoperative management.
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsuchiya
authors.forename: Kenitiro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ono
authors.forename: Takahisa
authors.initials: T
authors.lastname: Tainaka
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Murase
authors.forename: Hisami
authors.initials: H
authors.lastname: Ando
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome