Clinical Paper
Success and safety of endoscopic retrograde cholangiopancreatography in children,☆☆

https://doi.org/10.1016/j.jpedsurg.2017.01.051Get rights and content

Abstract

Purpose

Despite its diagnostic and therapeutic utility, endoscopic retrograde cholangiopancreatography (ERCP) is underutilized in children.

Methods

Patients younger than 18 years undergoing ERCP from 2000 to 2014 at a children's hospital were identified. Patient characteristics and outcomes were evaluated.

Results

Overall, 215 ERCPs (78% therapeutic) were performed in 184 patients. Our cohort was 67% female, with a median age (IQR) of 14 (8) years. Common indications were choledocholithiasis, pancreatitis, sclerosing cholangitis, and postoperative complication. ERCP was performed with an adult duodenoscope in 96% of cases and with a pediatric duodenoscope in the remainder. Patients requiring a pediatric scope ranged in weight from 4.3 to 22.8 kg, with ages from 2 months to 6 years. Cannulation was successful in 97% of cases. Findings included bile duct (BD) stones, BD dilatation, sclerosing cholangitis, BD stricture, pancreatic duct (PD) disruption, choledochal cyst, pancreas divisum, and BD leak. The most common therapeutic techniques were sphincterotomy, stone extraction, and stent. Complication rate was overall 10% with no deaths. On multivariate analysis, PD cannulation was associated with pancreatitis (OR 3.48), while age < 4 years (10.7), male gender (12.8), and precut sphincterotomy (31.3) were associated with hemorrhage (all p < 0.05).

Conclusion

ERCP can be performed successfully and safely in children with complication rates comparable to those in adults. The type of cannulation and patient age are independent risk factors for complications.

Level of evidence

Treatment study—IV.

Section snippets

Materials and methods

All patients younger than 18 years undergoing ERCP from January 1, 2000 to December 31, 2014 at Holtz Children's Hospital, Miami, FL were identified by retrospective chart review. All of the ERCP procedures were performed by a single, experienced surgical endoscopist trained in laparoscopic general surgery and advanced endoscopy. The adult duodenoscopes included the following: TJF-160F, with an outer diameter (OD) of 11.3 mm with a single 4.2 mm instrument channel, and JF-140F, with an OD of 11.0 

Results

Overall, 215 ERCPs were performed in 184 patients. Seventy-eight percent of cases were performed for therapeutic purposes, whereas the remaining 22% were for diagnostic indications. Of the cohort, 67% were female, and median age (IQR) was 14 (8) years. Many of the patients had ultrasonography (70%) or magnetic resonance cholangiopancreatography (43%), while 61% had related operations including biliary (45%), hepatic (14%) and pancreatic (2%) procedures before or after ERCP. Common indications

Discussion

Pancreatic and bile duct diseases lead to a substantial number of hospitalizations and surgical interventions in adults. The incidence of pancreaticobiliary problems in children, however, is less common. Although recent research has emerged in support of ERCP in pediatric cases [1], [5], [6], [7], [8], [9], much of the research is extrapolated from small study populations. Our review of 215 ERCPs performed on 184 patients supports the notion that ERCP can be used as a safe and effective means

Conclusions

Our study provides pediatric data comparable to that of adults regarding indications, usage, complications, and successful cannulation. The absence of any mortality or serious complications supports the safe use of ERCP in pediatric patients. This study shows the value of ERCP as a nonsurgical intervention which may be safely applied to a pediatric population for diagnosis and treatment of pancreaticobiliary disease.

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Author Disclosure Statement: The authors have no financial affiliations to disclose.

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Author Contributions: JMM, EAP, JES, and JT contributed to study conception and design. JMM, EAP, AEW, RMV, and AK contributed to the acquisition of data. JMM, EAP, JT, AEW, and JES contributed to the analysis and interpretation of data. JMM, JDR, RSL, EAP, JT, and JES contributed to the drafting of the manuscript. All authors contributed to the critical revision of the manuscript.

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