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Technical outcomes and complications of ERCP in children
Shyam Varadarajulu1, C Mel Wilcox, Robert H Hawes
1Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, 410 Lyons Harrison Research Building, 701 19th Street South, Birmingham, AL 35294, USA.
Insights
Pediatric Endoscopic Retrograde Cholangiopancreatography (ERCP) demonstrates comparable success and complication rates to adult ERCP when performed by expert endoscopists. This study highlights the safety and efficacy of ERCP in children.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Interventional Endoscopy
Background:
- Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex procedure.
- Limited data exists comparing ERCP outcomes in pediatric versus adult populations.
Purpose of the Study:
- To compare the technical success and complication rates of diagnostic and therapeutic ERCP in pediatric patients (<18 years) versus adult patients.
Main Methods:
- A retrospective case-controlled study matched pediatric and adult ERCP patients based on indication and procedure complexity.
- Outcomes were analyzed from 1994-2002 across two centers.
- Established criteria were used to define procedure complexity and complications.
Main Results:
- 116 children and 116 matched adults underwent ERCP.
- Success rates were high and comparable: 97.5% in children versus 98% in adults (p=not significant).
- Complication rates were also similar: 3.4% in children versus 2.5% in adults, with most mild and associated with complex (grade III) procedures.
Conclusions:
- ERCP in children by expert endoscopists yields high success and low complication rates.
- Pediatric ERCP outcomes are comparable to those in adult patients.
- ERCP is a safe and effective therapeutic option for pediatric patients.
Background:
The aim of this study was to compare the success and complications of diagnostic and therapeutic ERCP in children (age <18 years) and adult patients.
Methods:
A retrospective case-controlled study was conducted in which all children undergoing ERCP at two centers (1994-2002) were identified from endoscopy databases and were matched with adult patients for all variables (e.g., indication, procedure complexity) except age. Outcomes with regard to technical success and complications were compared between the adult and the pediatric cohorts. Grade of procedure complexity and procedure-related complications were defined by using established criteria.
Results:
A total of 116 children (mean age 9.3 years, range 1 month to 17 years; median age 8.1 years) and 116 matched adult patients (mean age 56.3 years, range 20-83 years; median age 49.7 years) underwent 163 and 173 ERCP procedures, respectively. According to procedure complexity grade, each group included the same number of patients, grade I, 72 patients; grade II, 12 patients; and grade III, 32 patients. Procedure success rate was 97.5% in children vs. 98% in the adult cohort (p= not significant). The complication rate was not significantly different between children and adult patients (3.4% vs. 2.5%). Most complications were of mild severity and encountered only in patients who underwent grade III procedures, with the exception of a single adult in whom moderate post-sphincterotomy bleeding developed after extraction of a large bile duct stone (grade II complexity).
Conclusions:
When ERCP is performed in children by expert endoscopists, the success rate is high and the complication rate is low, both being comparable with those for ERCP in adult patients.
