Safety and Effectiveness of ERCP in the Pediatric Population: A Tertiary Care Center Experience

Background and Aim: Pediatric ERCP remains significantly less studied compared to its application in adults, particularly in infants, due to the limited procedural volume. This study aims to evaluate the indications, procedural specifics, technical success rates, and adverse events associated with pediatric ERCP at a tertiary care center over an 18-year period, with specific attention to patients weighing less than 10 kg. Methods: A retrospective analysis of all ERCPs performed on patients under 18 years of age at ISMETT between 2005 and 2023. Demographic data, indications, procedural specifics, outcomes, and adverse events were collected and reported. Subgroup analyses focusing on initial ERCP procedures were performed and stratified by weight and indication type. Results: 194 ERCPs were performed on 84 patients. Acute or chronic pancreatitis was the most common indication. Technical success was high across weight groups. Adverse events occurred only in patients ≥ 10 kg (7%), predominantly post-ERCP pancreatitis. No adverse events were reported in the <10 kg group. In the "first-ERCP" subgroup, pancreatic indications were associated with a higher adverse event rate than biliary indications, although the estimate was imprecise owing to the small number of events. Conclusions: In our experience as a specialized center, pediatric ERCPs have proven to be safe and effective, even in infants < 10 kg. Pancreatic indications appeared to carry a higher risk for adverse events than biliary indications, although this estimate was imprecise.