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Endoscopic retrograde cholangiopancreatography is useful and safe in children
Catherine Paris1, Jimmy Bejjani, Mona Beaunoyer
1Department of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec, Canada.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is a safe and effective diagnostic and therapeutic tool for pediatric patients. This study found ERCP in children has a complication rate similar to adults, though general anesthesia is more common.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Hepatobiliary Diseases
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is a standard procedure for adults.
- Its application and safety in pediatric populations are less established.
- Increasing use necessitates data on pediatric ERCP outcomes.
Purpose of the Study:
- To review the experience, safety, and utility of ERCP in a pediatric tertiary university center.
- To evaluate the outcomes of ERCP procedures performed on children.
Main Methods:
- Retrospective chart review of pediatric patients undergoing ERCP from 1990 to 2007.
- Data collected included demographics, diagnoses, anesthesia, treatments, and complications.
- Analysis of 38 ERCPs in 29 pediatric patients.
Main Results:
- ERCP was successful in 97% of cases, primarily for chronic pancreatitis (76%) and bile duct obstruction (21%).
- The overall complication rate was 13.5%, with no severe events like perforation or bleeding.
- General anesthesia was used in 74% of pediatric procedures.
Conclusions:
- ERCP is a safe and useful diagnostic and therapeutic intervention for children.
- Pediatric ERCP complication rates are comparable to adult rates.
- General anesthesia is frequently required for pediatric ERCP, highlighting the need for experienced endoscopists.
Purpose:
Endoscopic retrograde cholangiopancreatography (ERCP) is a recognized diagnostic and therapeutic tool in the adult population. Its use in children has been more common in the last years. There are little data on safety and usefulness of that procedure in children. The aim of this study was to review the experience with ERCP in a tertiary university center dedicated to children.
Method:
We conducted a retrospective chart review of patients seen at the Centre Hospitalier Universitaire Ste-Justine (Montreal, Quebec, Canada) who had undergone an ERCP between September 1990 and July 2007. Data on demographics, diagnosis, anesthesia type, treatments, and complications were collected.
Results:
Thirty-eight ERCPs were performed on 29 patients. There were 21 girls (72%), and median age at time of procedure was 10.3 years old (range, 3-17 years). Most had only one procedure performed. Two children had 2 interventions, and 1 child with papillary stenosis had 8 interventions linked to stent treatment. The ampulla was cannulated, and the procedure was successfully completed in 97% (37/38) of cases. General anesthesia and sedation were performed in 74% and 26% of procedures, respectively. Indications for ERCP were 29 recurrent or chronic pancreatitis (76%), 8 common bile duct obstructions (21%), and 1 choledochal cyst (3%). Endoscopic treatment was done in 29% of cases. The complication rate was 13.5%, and 4 clinical acute pancreatitis resolved with conservatory treatment. No severe pancreatitis, perforation, or bleeding was noted. Of the patients, 79% had their follow-up at the Centre Hospitalier Universitaire Ste-Justine for a median length of 43 months (range, 1-53 months).
Conclusion:
Endoscopic retrograde cholangiopancreatography is used as a diagnostic and therapeutic procedure in children with a complication rate similar to that seen in adults. The need for general anesthesia is much more frequent with children. When performed by well-trained endoscopists, ERCP is useful and safe in children.
