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Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious
Brintha K Enestvedt1, Christina Tofani, Dale Y Lee
1*Department of Medicine, Division of Gastroenterology, Temple University School of Medicine †Department of Medicine, University of Pennsylvania Perelman School of Medicine ‡Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia §Department of Medicine, The Children's Hospital of Philadelphia, Philadelphia PA ||Department of Medicine, Division of Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
Pediatric Endoscopic Retrograde Cholangiopancreatography (ERCP) is effective and safe for diagnosing and treating biliary and pancreatic issues in children. High success rates and low adverse events support its use by experienced specialists at high-volume centers.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Hepatobiliary and Pancreatic Diseases
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly utilized for pediatric biliary and pancreatic disorders.
- This study reviews the experience with pediatric ERCP at a major academic referral center.
Purpose of the Study:
- To evaluate the efficacy and safety of ERCP in a pediatric population.
- To compare pediatric ERCP outcomes with adult data.
Main Methods:
- Retrospective review of medical records for patients aged 0-21 years undergoing ERCP (1993-2011).
- Data included indications, technical success (duct cannulation), and serious adverse events (bleeding, perforation, pancreatitis, death).
Main Results:
- 429 ERCPs performed on 296 pediatric patients; mean age 14.9 years.
- Technical success rate was 95.2%; therapeutic intervention in 64.1%.
- Serious adverse events occurred in 7.7% of procedures.
Conclusions:
- Pediatric ERCP demonstrates high efficacy and safety, comparable to adult outcomes.
- Low rates of serious adverse events support its use.
- Experienced endoscopists at high-volume centers should perform pediatric ERCP.
Background:
Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly being used in the evaluation and management of biliary and pancreatic disorders in children. The aim of this study was to review the pediatric ERCP experience of a large academic referral center affiliated with a tertiary care children's hospital.
Methods:
This is a retrospective review of medical records, endoscopic and operative reports, and radiography of those patients ages 0 to 21 years who underwent ERCP for any indication between 1993 and 2011 at a tertiary referral center affiliated with a large urban pediatric hospital. ERCP technical success was defined as cannulation of the desired duct. Serious adverse events included bleeding, perforation, pancreatitis, or death.
Results:
Four hundred twenty-nine ERCPs were performed on 296 patients. The mean age was 14.9 ± 4.8 years (3 months-21 years); 51.1% were boys. Patients with a history of previous liver transplant comprised 13.1% (56) of all ERCPs. Abnormal liver chemistries or suspected choledocholithiasis accounted for half of the indications. A therapeutic intervention was performed in 64.1%. Technical success was achieved in 95.2% of ERCPs. Serious adverse events occurred in 7.7%.
Conclusions:
Pediatric ERCP is highly efficacious in the pediatric population, with the rates of technical success and use of therapeutic interventions mirroring those in adults. There is a low overall rate of serious adverse events. The overall efficacy and safety support the performance of pediatric ERCP by experienced endoscopists at high-volume centers.
