Early adverse events and long-term outcomes of endoscopic sphincterotomy in a pediatric population: a single-center experience

Abstract

The use of endoscopic sphincterotomy (EST) in the management of pancreaticobiliary disease in children is increasing. However, studies of long-term outcomes are limited in pediatric patients. Therefore, this study evaluated the early adverse events and long-term outcomes following EST in pediatric patients. We retrospectively analyzed data from 198 pediatric patients who underwent ESTs at Asan Medical Center Children's Hospital between 1994 and 2013. The median age was 8.7 years (range 18 months to17 years). We evaluated the indications, success rates, early adverse events, and long-term outcomes. Long-term information was available in 198 patients with a median follow-up duration of 42 months (range, 1.8 - 232.1 months). Early adverse events (< 30 days) following 294 ESTs among 198 patients included pancreatitis in 17 (5.7 %), hemorrhages in 6 (2.0 %), sepsis in 3 (1.0 %), and perforations in 2 (0.7 %). Long-term complications ( > 30 days) developed in 12 patients (6.1 %), including cholangitis with or without bile duct stone (n = 7), and minor papilla restenosis (n = 5). The cumulative incidence rates of long-term complications were 3.1 %, 6.1 %, 9.3 %, and 9.3 %, at 1, 5, 10, and 15 years. There were no procedure-related pancreaticobiliary malignancies or deaths. All adverse events and long-term complications improved with appropriate management. In pediatric patients with pancreaticobiliary disease, EST has a high level of technical success. In addition, pediatric EST showed low rates of early adverse events and long-term complications, which could be managed safely. Our results suggest that EST is a safe method for treating pancreaticobiliary disease, even in the pediatric population.

Chronic pancreatitis in children: between gastroenterologist and surgeon

“…Систематический анализ, проведенный Cho JM и соавт., показал, что общая частота осложнений эндоскопического лечения составляет 6% (95% доверительный интервал 4-8%), включая постэргический панкреатит (4,7%), кровотечение (0,6%) и инфекции (0.8%) [45].Факторы риска развития постэргического панкреатита у детей включают: инъекцию контраста в панкреатический проток и панкреатическую сфинктеротомию.…”

Advanced Therapeutic Gastrointestinal Endoscopy in Children – Today and Tomorrow

“…The safety of ERCP has been evaluated in several recent studies [ 10 , 16 , 17 ]. A recent systematic review and meta-analysis has shown a pooled complication rate of 6% (95% confidence interval 4%–8%) including post-ERCP pancreatitis (4.7%), bleeding (0.6%), and infections (0.8%) [ 17 ].…”

“…The risk factors for post-ERCP pancreatitis in children include injection of contrast into the pancreatic duct and pancreatic sphincterotomy [ 18 ]. Cho et al, analyzed the adverse events and long-term outcomes associated with an endoscopic sphincterotomy in a pediatric population [ 16 ]. In this retrospective study, early adverse events (<30 days) included pancreatitis (5.7%), bleeding (2.0%), sepsis (1.0%), and perforations (0.7%).…”

“…In this retrospective study, early adverse events (<30 days) included pancreatitis (5.7%), bleeding (2.0%), sepsis (1.0%), and perforations (0.7%). Long-term adverse events (>30 days) including cholangitis and minor papilla restenosis were noticed in 6.1% of children [ 16 ]. Post-ERCP pancreatitis is the most common adverse event as mentioned above.…”

Endoscopic sphincterotomy in pediatric patients: do we know enough?

“…Most studies on ERCP in children are retrospective in design and involve small numbers, mainly because of the overall small proportion of procedures compared to those in adult populations. In this issue of Endoscopy, Cho et al have tried to fill in some of the gaps, by evaluating the early adverse events and long-term outcomes following 294 endoscopic sphincterotomies in 198 children with pancreaticobiliary diseases [5]. This retrospective single-center study from Korea has a follow-up duration of median 3.5 years with a wide range (2 -232 months).…”