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Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study
Clémence Mercier1, Mathieu Pioche2, Eliane Albuisson3
1Department of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Nancy, Nancy, France.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is a safe and effective procedure for children with pancreaticobiliary diseases, demonstrating high success rates and manageable adverse events comparable to previous studies.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure for diagnosing and treating pancreaticobiliary conditions.
- Data on the safety and efficacy of ERCP specifically in pediatric populations, particularly across multiple centers, remains crucial for clinical practice guidelines.
Purpose of the Study:
- To evaluate the technical success and safety profile of ERCP procedures performed in pediatric patients across French and Belgian centers.
- To identify factors associated with adverse events following ERCP in children.
Main Methods:
- A retrospective multicenter study including 271 children (aged 1 day to 17 years) who underwent 470 ERCP procedures between 2008 and 2019.
- Data collected included indications, procedural success rates, and types and rates of complications, with clinical follow-up for 72% of procedures.
Main Results:
- The overall complication rate was 19%, with post-ERCP pancreatitis (12%) and sepsis (5%) being the most common. Pancreatic stent removal was protective against post-ERCP pancreatitis.
- Technical success rates were high: biliary cannulation (92%), pancreatic cannulation (96%), and therapeutic procedures (92%). Sepsis was associated with a history of liver transplantation.
- No procedure-related mortality was observed, and all complications were managed conservatively.
Conclusions:
- ERCP can be performed safely and effectively in pediatric patients for a range of pancreaticobiliary diseases.
- The complication rates and outcomes observed in this large cohort are comparable to those reported in adult studies and previous pediatric series.
Introduction:
The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers.
Methods:
All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included.
Results:
271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 - 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 - 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality.
Conclusion:
Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.
