Complications of Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients; A Systematic Literature Review and Meta-Analysis

Abstract

Objectives To systematically review risks and summarize reported complication rates associated with performance of ERCP in children over the past two decades. Study design A systematic literature search of MEDLINE, Embase, and Web of Science from Jan 1995 to Jan 2016 was conducted for observational studies published in English. Studies reporting ERCP complications in patients <21 years without history of liver transplant or cholecystectomy were included. A summary estimate of the proportion of children who experienced complications following ERCP was derived using a random effects meta-analysis. Results Thirty-two studies involving 2612 children and 3566 procedures were included. Subjects’ ages ranged from 3 days to 21 years. Procedures were performed for biliary (54%), pancreatic (38%), and other (8%) indications. 56% of ERCPs were interventional. The pooled complication rate was 6% (95% CI: 4%– 8%). Procedural complications included post-ERCP pancreatitis (166, 4.7%), bleeding (22, 0.6%) and infections (27, 0.8%). The pooled estimate of post-ERCP pancreatitis was 3% (95%CI 0.02–0.05), and other complications were 1% (95%CI: 0.02–0.05). In neonatal cholestasis subgroup the pooled complication rate was 3% (95% CI: 0.01–0.07). Adult and pediatric gastroenterologists and surgeons performed the ERCPs. Available data limited the ability to report differences between pediatric-trained and other endoscopists. Conclusions Complications associated with pediatric ERCP range widely in severity and are reported inconsistently. Our review suggests 6% of pediatric ERCPs have complications. Further studies using systematic and standardized methodologies are needed to determine the frequency and risk factors for ERCP related complications.

The Pancreas in Child Abuse

“…Of note, however, is the risk of ERCP-associated acute pancreatitis (20). A systematic review and meta-analysis of complications of ERCP in pediatric patients reported a complication rate of 6%, with post-ERCP pancreatitis representing the bulk of complications, and bleeding and infections associated with ERCP being less common (21). However, these patients represent a variety of disease states and ERCP intervention types, and the inclusion of chronic pancreaticobiliary disease cases likely increases the pooled complication rate.…”

Successful Therapeutic ERCP in a 99-Day-Old Child With Common Bile Duct Stones: A Case Report and Discussions on the Particularities of the ERCP in Children

“…The success rate of ERCP (∼90%) in children is similar to or slightly lower than that of adults (4). The older the age, the higher the success rate is (6), while the incidence of complications (0-10%) is similar to or slightly higher than that of adults (2,4,7). Such complications include perforation, bleeding and post-ERCP pancreatitis (PEP) (8).…”

Chronic pancreatitis in children: between gastroenterologist and surgeon

“…Полное удаление камней было произведено у 86% детей благодаря сочетанию литотрипсии и ЭРХПГ. Наиболее частым осложнением данной процедуры является панкреатит [44].…”