Endoscopic Retrograde Cholangio Pancreatography for children

An Endoscopic Retrograde Cholangio Pancreatography or ERCP for short, is a minimally invasive procedure that allows doctors to treat problems in the bile ducts and pancreatic duct. “Endoscopic” refers to the use of an endoscope, “retrograde” refers to going against the direction of the flow of bile, and “cholangio pancreatography” refers to making images of the bile ducts and pancreatic duct.

When is an ERCP required?

In India around 0.3 % of children get admitted to the hospital often because of severe pain or jaundice. Their symptoms may be caused by a gallbladder stone that slips into the bile duct and is blocking bile (a vital fluid that helps the body break down and absorb nutrients) from flowing freely through the bile ducts. Bile ducts are small channels so it’s not uncommon for a gallbladder stone to get stuck.

In certain cases, bile stones slip into the bile duct tube and causes severe pain. Stones in bile duct tubes need to be removed as they can lead to jaundice and severe infection termed as cholangitis. In such cases, the doctor may determine that ERCP is needed. The bile-duct stones are then removed endoscopically through the ERCP procedure.

If ERCP is not recommended for that patient, due to various reasons, the patient needs to undergo surgery by opening the bile duct tube. This is an invasive procedure compared to ERCP which is less invasive.

The Procedure

The ERCP procedure combines two components: an endoscopy and fluoroscopic x-rays:

During an endoscopy, when your child is under general anesthesia, the doctor guides an endoscope — a long, thin, flexible tube equipped with LED lights and a tiny video camera that transmits to several monitors in the room — into your child’s mouth and down into his/her upper digestive system.

Even though the endoscope is extremely narrow, it is divided into two “channels.” The doctor can use the channels to transfer air into the GI tract, to make sure there’s enough room for what he or she needs to visualize and treat. Some areas of the body (such as the bile ducts) are so small that in order to see into them, the doctor needs to use the endoscope to inject them with a special contrasting dye. This dye is visible in fluoroscopic x-rays, which are used to detect any abnormal narrowing or blockages in the duct.

Challenges

ERCP is a technically-demanding procedure that has developed significantly during the last 20 years with advanced diagnostic and therapeutic capabilities. Practitioners should have a full appreciation of the technical complexity and limitations of this procedure.

ERCP requires good technique even in adults as sometimes it can lead to severe complications. Paediatric ERCP is done only at high volume GI centers because of this reason. Further, the scope used for children is same as that used for adults, which is big in size for a small child, and hence there will be some difficulty.

– Article contributed by Dr. K. Arivarasan, MD, DM, Medical Gastroenterology, Kauvery Hospital, Cantonment, Trichy

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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