ERCP in the evaluation of abdominal pain in children
Kulwinder Dua1, Adrian Miranda, Raj Santharam
1Division of Gastroenterology and Hepatology, Froedtert Memorial Hospital, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is a safe and effective diagnostic tool for pediatric abdominal pain. It successfully identified causes and allowed interventions in children with and without initial objective findings.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Pancreatobiliary Imaging
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is recognized as a feasible and safe procedure in pediatric patients.
- The diagnostic utility of ERCP in children experiencing abdominal pain, particularly when objective findings are initially absent, requires further elucidation.
Purpose of the Study:
- To assess the diagnostic and therapeutic value of ERCP in evaluating children presenting with abdominal pain.
- To compare the outcomes of ERCP in children with and without objective biochemical or imaging evidence of pancreatobiliary disease.
Main Methods:
- A retrospective review was conducted at a single tertiary care center.
- Data from 185 pediatric patients who underwent ERCP between 1994 and 2004 were analyzed.
- Patients were stratified into two groups: those with objective findings (Group I) and those without (Group II).
Main Results:
- ERCP achieved a technical success rate of 98% in the pediatric cohort.
- In Group I, ERCP identified the cause of pain in 72% of cases, with 58% undergoing successful therapeutic intervention.
- In Group II, ERCP identified the cause of pain in 56% of cases, with 47% undergoing successful intervention, demonstrating significant diagnostic yield even without initial objective findings.
Conclusions:
- ERCP demonstrates a favorable risk-to-benefit ratio for diagnosing and managing pediatric abdominal pain suggestive of pancreatobiliary origin.
- The procedure is valuable in identifying pathologies even in children lacking initial objective evidence of disease.
- Complications were minimal, including mild pancreatitis and self-limited bleeding.
Background:
ERCP is feasible and safe in the pediatric population. Its utility in the evaluation of children with pain suggestive of a pancreatobiliary origin without objective findings compared with those with abnormal biochemical and/or imaging studies is not well known.
Objective:
To determine the utility of ERCP in the diagnosis and management of children seen with abdominal pain.
Design:
Retrospective review.
Setting:
One tertiary center.
Patients:
All children who underwent ERCP at one tertiary center from 1994 to 2004.
Method:
An endoscopy database was used. Data sets with regard to indications, technical success, complications, and outcomes were evaluated. Before ERCP, children with abdominal pain were categorized into 2 groups: group I, those with objective findings, namely abnormal biochemistry and/or abnormal imaging studies; group II, those who had abdominal pain without objective findings.
Main Outcome Measurements:
ERCP success and failure rates, findings, interventions, complications, and outcomes were determined. Data were compared between group I and group II.
Results:
A total of 185 consecutive children with abdominal pain who underwent ERCP were identified (131 in group I and 54 in group II). ERCP technical success was achieved in 98%. In group I, ERCP identified a cause for abdominal pain in 93 of 129 children (72%). Fifty-four of 93 patients (58%) in this group underwent endoscopic intervention with resolution of pain. In group II, a cause for abdominal pain was identified in 30 of 53 children (56%)(P < .025 compared with group I). Fourteen of 30 patients (47%) in this group underwent endoscopic intervention with resolution of pain. Complications noted were mild pancreatitis in two and self-limited bleeding in one.
Limitations:
A retrospective study, one tertiary center where the majority of the ERCPs were performed by one experienced operator.
Conclusions:
ERCP in children with abdominal pain suggestive of a pancreatobiliary origin has a favorable risk:benefit ratio.
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