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Pediatric ERCP: Evolving into an Outpatient Procedure
Monique T Barakat1,2, Andrew Yong-Jueen Liman2, Roberto Gugig3,4
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Insights
Outpatient pediatric ERCP (endoscopic retrograde cholangiopancreatography) is safe, with no increased adverse events compared to inpatient procedures. This approach can be considered for select pediatric patients undergoing ERCP.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Health Services Research
Background:
- Pediatric ERCP (endoscopic retrograde cholangiopancreatography) is typically inpatient-based.
- A shift towards outpatient pediatric ERCP is emerging, guided by clinical judgment.
- This study compares outcomes of outpatient versus inpatient pediatric ERCP.
Purpose of the Study:
- To compare patient characteristics, indications, and adverse events between outpatient and inpatient pediatric ERCP.
- To identify factors influencing the decision for outpatient versus inpatient pediatric ERCP.
- To evaluate the safety of outpatient pediatric ERCP.
Main Methods:
- Retrospective analysis of pediatric ERCP (age ≤18) from 2019-2021.
- Data collected included demographics, hospitalization status, indications, findings, interventions, and adverse events.
- Comparison between outpatient (n=51) and inpatient groups (n=96).
Main Results:
- No statistically significant differences were observed in patient age, indications, or ERCP type (index vs. subsequent) between outpatient and inpatient groups.
- Overall ERCP-associated adverse event rates were low in both groups.
- There was no significant difference in adverse events between pediatric patients undergoing outpatient versus inpatient ERCP.
Conclusions:
- Outpatient pediatric ERCP is a safe option for select patients, with no increased risk of adverse events compared to inpatient ERCP.
- Clinical judgment can guide the safe selection of pediatric patients for outpatient ERCP.
- Further prospective, multi-center studies are warranted to validate these findings.
Background:
While most adult ERCPs are performed on an outpatient basis, pediatric ERCPs are typically performed on an inpatient basis, or with ERCP followed by at least one night inpatient admission. We have begun performing a substantial proportion of our pediatric ERCPs on an outpatient basis, using our clinical judgment to guide the decision process. In the present study, we compare patient characteristics, indications, and adverse events associated with outpatient vs. inpatient ERCP.
Methods:
Using our endoscopy database, we identified patients 18 years of age and under who underwent ERCP from 2019 to 2021. Demographics, hospitalization status, indications, findings, interventions, as well as available adverse event and clinical outcomes data were analyzed.
Results:
147 ERCP procedures were performed during the study period by one of two interventional endoscopists. A subset of 51 (34.7%) patients underwent outpatient ERCP. Comparison of the two groups (outpatient vs. inpatient ERCP) was notable for no statistically significant difference in patient age, range of indications, or proportion of index vs. subsequent ERCP. Overall rates of ERCP-associated adverse events were low and there was no statistically significant difference between adverse events in patients who underwent outpatient vs. inpatient ERCP.
Conclusion:
We analyzed outpatient and inpatient pediatric ERCP patient demographics and ERCP characteristics to identify factors that guide decision to determine whether pediatric ERCPs are performed on an outpatient vs. inpatient basis. There was no significant difference in adverse events associated with outpatient vs. inpatient pediatric ERCPs, attesting to the safety of outpatient ERCP for this subset of patients in the studied context. This is an area worthy of future prospective and multi-center study.
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