Children, Cholangiopancreatography, Endoscopic Retrograde, Cholecystolithiasis, Choledocholithiasis, Common Bile Duct Calculi, Laparoscopic Cholecystectomy in Children
Conditions
Keywords
Children, Endoscopic retrograde cholangiopancreatography (ERCP), Сholedocholelysis, Common Bile Duct Calculi
Brief summary
Chronic calculous cholecystitis in pediatric patients leads to choledocholithiasis in about 12% of cases. These patients require removal of stones from the common bile duct. The most common method of cleaning the common bile duct is endoscopic retrograde cholangiopancreatography, and the standard technique for removing the gallbladder is laparoscopic cholecystectomy. There are different approaches to the treatment of this category of patients: laparoscopic common bile duct exploration (LCBDE), laparoendoscopic rendezvous method (LERV) and one-stage LC after ERCP. Given the inflammation of the gallbladder and the inflammatory process in the hepatoduodenal ligament, early laparoscopic cholecystectomy can lead to various intraoperative complications. The aim of this retrospective study is to evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy with laparoscopic cholecystectomy in a delayed manner (single or repeated hospitalization).
Detailed description
There is no gold standard for the treatment of cholecystocholedocholithiasis in the pediatric population. The most common method for resolving biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC). There are different approaches to the treatment of cholecystocholedocholithiasis: laparoscopic common bile duct exploration (LCBDE), laparoendoscopic rendezvous method (LERV) and LC after ERCP. Both LCBDE and LERV allow for the simultaneous treatment of cholecystocholedocholithiasis. However, many medical institutions do not have the opportunity to use these methods due to the difficulties of implementation and the need for specialized training and experience of specialists. The timing of LC after ERCP in patients with cholecystocholedocholithiasis remains a subject of debate. The present study aims to compare ERCP with ES + delayed LC in intra- and re-hospitalization in pediatric patients with cholecystocholedocholithiasis. The aim of this study is to evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy with laparoscopic cholecystectomy in a delayed manner (single or repeated hospitalization).
Interventions
Initially, ERCP with EST was performed by an endoscopist with the consent of the patient or legal representative. The patients underwent endoscopic procedures using fluoroscopy in the operating room, under general anesthesia. Subsequently, laparoscopic cholecystectomy was performed on a delayed basis, 7 to 15 days after ERCP in a single hospitalization
Sponsors
Moscow Regional Research and Clinical Institute (MONIKI)
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
0 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Informed consent from child or legal guardian * Age 0-18 years * Acute cholecystitis * Choledocholithiasis
Exclusion criteria
* Unwillingness or inability to consent to the study * Previous ERCP or percutaneous transhepatic biliary drainage * Benign or malignant stricture * Preoperative comorbidities: gastrointestinal bleeding, severe liver disease, acute and chronic cholangitis, septic shock. * In combination with Mirizzi syndrome and intrahepatic bile duct stones * Congenital anomaly of the biliary tract * Malignant neoplasms * Acute pancreatitis before the procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence of common bile duct stones | 60 days after ERCP | The diagnosis of the stone in the common bile duct was made by MRI, CT scan and ultrasound, if confirmed, before performing laparoscopic cholecystectomy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute pancreatitis | 30 days after ERCP | at least two out of three criteria according to the classification developed by the INSPPIRE group |
| Duration of the laparoscopic cholecystectomy,min | From enrollment to the end of treatment (3 month) | — |
| Bleeding | 30 days after ERCP | — |
| Perforation | 30 days after ERCP | by CT, radiography (fluid or gas in the retroperitoneal space or abdominal cavity, visual picture during endoscopic examination) |
| Technical success | 1 month | \- success of the procedures as documented by a yes or no |
| Acute cholangitis | 60 days after ERCP | intermittent chills, fever, increased proinflammatory blood markers after ERCP |
| Bile duct stricture | 1 year after ERCP | after ERCP |
| Time spent in hospital until discharge | from admission to hospital until the end of treatment (up to 8 weeks) | — |
| Duration of the Endoscopic retrograde cholangiopancreatography,min | From enrollment to the end of treatment (3 month) | — |
| Bile leak | 30 days after ERCP | bile aspirated from the abdominal cavity |
Countries
Russia
Outcome results
None listed