Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience

Kieling, Carlos Oscar; Hallal, Cristiane; Spessato, Camila O.; Ribeiro, Luciana Maria de Andrade; Breyer, Helenice Pankowski; Goldani, Helena Ayako Sueno; Maguilnik, Ismael

doi:10.1007/s12519-014-0518-5

Cited by 24 publications

(9 citation statements)

References 43 publications

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“…In children between 1 and 18 years, 63.2 % of ERCP procedures were therapeutic, which is comparable to other publications [1,11,12]. PEP was seen in 10.4 %, which is similar to others [1,12,13]. However, other studies have demonstrated lower rates of pancreatitis [10].…”

Section: Discussionsupporting

confidence: 87%

Endoscopic retrograde cholangiopancreatography in infants and children

Åvitsland

Aabakken

2021

Endosc Int Open

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Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

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Section: Discussionsupporting

confidence: 87%

Endoscopic retrograde cholangiopancreatography in infants and children

Åvitsland

Aabakken

2021

Endosc Int Open

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“…Literatürde çocuklarda ERCP'nin en sık endikasyonu olarak tekrarlayan pankreatit bildirilmiştir (7,11,14). ERCP komplikasyonlarının incelendiği bir metaanalizinde, 2612 çocuk ve 3666 işlemde %54 biliyer, %38 pankreatik ve %8 diğer endikasyonlarla ERCP yapıldığı belirlenmiş ve ortalama komplikasyon oranı %6 olarak bulunmuştur (15).…”

Section: Discussionunclassified

“…Çalışmamızda hastaların %50'sine biliyer, %50'sine pankreatik endikasyonla ERCP yapılmış olup, pankreatik endikasyonların da biliyer endikasyonlar kadar çok olduğu görülmüştür. ERCP'de papilla kanülasyonunda literatürde bildirilen başarı oranı %89,5 ile %97,5 arasında değişmektedir (14,16). Çalışmamızda da ERCP yapılan 46 hastanın %97,8'inde başarılı kanülasyon sağlandı.…”

Section: Discussionunclassified

Endoscopic Retrograd Colangiopancreatography in Children: A Single Center Experience

Onat¹,

Demirtaş²,

Gülşen³

et al. 2021

jcp

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Giriş: Endoskopik retrograde kolanjiopankreatografi (ERCP) endoskopi ile fluoroskopiyi birlikte kullanan pankreas ve safra yolları hastalıklarında tanı ve tedavi imkanı sağlayan işlemdir. Gereç ve Yöntem: Hacettepe Üniversitesi Tıp Fakültesi Gastroenteroloji Endoskopi Ünitesinde Kasım 2017 -Nisan 2020'de ERCP yapılan 46 çocuk hastanın verileri retrospektif incelendi. Bulgular: Yirmi üç hastada biliyer, 23'ünde pankreatik endikasyonla olmak üzere 46 hastaya (29 K, %63,04) toplam 77 (1-5) ERCP işlemi yapıldı. Yaş ortalaması 10,3±4,07 (2,08 -17) yıldı. En küçük hasta 12,6 kg idi. ERCP endikasyonları; 16 hastada koledok taşı şüphesi (%34,8), 9 hastada kronik pankreatit (KP) ve ağrı (%19,6), 8 hastada rekürren akut pankreatit atakları (RAP, %8,7), 4 hastada KP ve RAP (%8,7), 3 hastada karaciğer nakli ve kolestaz (%6,5), 2 hastada benign biliyer darlık (BBD) (%4,3) ve 1 hastada sarılık nedeniyle hastalık ekartasyonu için (%2,2), 1 hastada profilaktik pankreatik stent uygulanması (%2,2), 1 hastada safra yolu ile ilişkili kist hidatik (%2,2) ve 1 hastada pankreas fistülü (%2,2) idi. ERCP'de, 14 (%30,4) KP, 7 (%15.2) koledok kisti, 11 (%23,9) koledok taşı, 4 (%8,7) Oddi sfinkter disfonksiyonu, 3 (%6,5) BBD, 3 (%6,5) anastomoz darlığı, 1 (%2,2) pankreas fistülü, 1 (%2,2) safra yolu ile ilişkili kist hidatik tanıları konuldu. Hastaların 6'sında (%13) anormal pankreatikobiliyer bileşke ve 5'inde (%10.9) pankreas divisium tespit edildi. Hastaların 37'sine (%80,4) endoskopik sfinkterotomi, 10'una (%21,7) dilatasyon yapıldı. 22'sinden (%47,8) taş çıkarıldı ve 27'sine (%58,6) stent takıldı. Pankreatit, kanama, perforasyon gibi major komplikasyon olmadı. Sonuç: Pediyatrik yaş grubunda ERCP'nin deneyimli kişiler tarafından yapıldığı taktirde çocuklarda oldukça güvenilir, etkili bir tanı ve tedavi yöntemidir.

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“…EUS, MRCP, and ERCP are the main diagnostic techniques for pancreatobiliary diseases [ 6 ] . For many years, ERCP has been considered the best preoperative diagnostic tool for the examination of the bile duct, although the related complication rate ranges from 5% to 10% in adults [ 4 , 9 , 19 ] and 3.4% to 28.5% in children [ 7 ]. Regarding the role of endoscopy in the management of suspected choledocholithiasis, the most recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines indicate that clinicians should always perform a non-invasive test, such as EUS or MRCP, before ERCP [ 4 , 6 , 9 , 19 ] .…”

Section: Discussionmentioning

confidence: 99%

The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature

et al. 2017

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BackgroundThe role of endoscopic ultrasound (EUS) in the management of pancreatobiliary and digestive diseases is well established in adults, but it remains limited in children. The aim of this study was to evaluate the feasibility, safety, and clinical impact of EUS use in children.MethodsThis is a retrospective analysis of a prospectively acquired database of consecutive pediatric (< 18 years) patients presenting an indication for EUS for pancreatobiliary and gastrointestinal disorders.ResultsBetween January 2010 and January 2016, 47 procedures were performed in 40 children (mean age of 15.1 ± 4.7 years; range 3–18). The majority of EUS (n = 32; 68.1%) were performed for pancreatobiliary and upper gastrointestinal pathologies, including suspected common bile duct stones (CBDs), acute biliary pancreatitis, recurrent/chronic pancreatitis, cystic pancreatic mass, recurrent hypoglycemia, duodenal polyp, gastric submucosal lesion, and perigastric abscess. In only 2 out of 18 children with suspected CBDs or acute biliary pancreatitis, EUS confirmed CBDs. EUS-guided fine needle aspiration was performed in 3 (6.4%) patients. Fifteen (31.9%) procedures were performed for lower gastrointestinal tract disorders, including suspected anal Crohn’s disease, fecal incontinence, and encopresis. Overall, EUS had a significant impact on the subsequent clinical management in 87.2% of patients.ConclusionThe present findings were consistent with results observed in the current relevant literature and support EUS as a safe and feasible diagnostic and therapeutic tool, which yields a significant clinical impact in children with pancreatobiliary and gastrointestinal disorders.

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Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience

Abstract: Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic ultrasound. All these procedures are complementary and ERCP still has a role for therapeutic purposes.

Cited by 24 publications

References 43 publications

Endoscopic retrograde cholangiopancreatography in infants and children

Endoscopic retrograde cholangiopancreatography in infants and children

Endoscopic Retrograd Colangiopancreatography in Children: A Single Center Experience

The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature

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