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Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International
David M Troendle1, Wenly Ruan2, Douglas S Fishman2
1From the UT Southwestern Medical Center, Children's Health Children's Medical Center, Dallas, TX.
Insights
Pediatric endoscopic retrograde cholangiopancreatography (ERCP) is safe and effective, with high success rates and manageable adverse events. The Pediatric ERCP Database Initiative (PEDI) provides valuable data for future pediatric ERCP research.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Clinical Outcomes Research
Background:
- Multicenter prospective studies on endoscopic retrograde cholangiopancreatography (ERCP) are extensive in adults but lacking in pediatric populations.
- The Pediatric ERCP Database Initiative (PEDI) was established to address this gap by collecting data on pediatric ERCPs.
Purpose of the Study:
- To evaluate the indications and technical outcomes of ERCP in pediatric patients.
- To identify factors associated with technically successful procedures and adverse events in pediatric ERCPs.
Main Methods:
- A prospective cohort study involving 15 centers.
- Data collection included pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event forms for each ERCP.
- Univariate and stepwise linear regression analyses were performed.
Main Results:
- 1124 ERCPs were performed on 857 pediatric patients (median age 13.5 years).
- Technical success rate was 90.5%, higher for biliary indications (OR 4.2).
- Common adverse events included post-ERCP pancreatitis (5%), pain (1.8%), and bleeding (1.2%).
Conclusions:
- ERCP is a reliable and safe procedure in the pediatric population.
- The PEDI is a valuable resource for evaluating pediatric ERCP outcomes.
- PEDI has the potential for future research in pediatric ERCP.
Objectives:
Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs.
Methods:
In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events.
Results:
A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified.
Conclusions:
This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.
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