Endoscopic retrograde cholangiopancreatography in infants and children

Abstract

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.

Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates

“…This database proved useful in its ability to compare trends and outcomes amongst different demographics. Overall complication rates were on the lower end of what has been reported, with recent retrospective studies estimating complications in pediatric ERCP to be as high as 9.4-20.7% [1,8,10,14,15]. Despite no significant variation in the complication risk between pediatric age groups, it bears consideration that the highest complication rate occurred in the youngest age group (0 -5), and younger patients were less likely to undergo routine home discharge.…”

“…This database proved useful in its ability to compare trends and outcomes amongst different demographics. Overall complication rates were on the lower end of what has been reported, with recent retrospective studies estimating complications in pediatric ERCP to be as high as 9.4-20.7% [ 1 , 8 , 10 , 14 , 15 ].…”

“…Single-center studies often do not report on differences in indications and risks across pediatric age groups. Infants and younger children are naturally more challenging due to limited navigational space and may require smaller endoscopes with instrument channel limits that make intervention difficult [6][7][8]. Additionally, congenital mutations and anatomic irregularities are present in a higher percentage of infants and young children presenting for ERCP when compared to the adolescents, who are more likely to present with obstructive biliary stones [9].…”

Choledochal Cyst: Clinical Features, Diagnosis and Treatment Perspectives

“…However, ERCP relies on experienced personnel to perform the procedure, with a 10% rate of complications such as pancreatitis, infection, or bleeding. [52]. Intraoperative cholangiography (IOCG), like ERCP, is not indicated as a routine diagnostic method, it is only suggested in exceptional cases where previous studies have not been conclusive.…”

Pediatric ERCP: Factors for Success and Complication—A 17-Year, Multisite Experience

“…To date, our understanding of these factors is incomplete. Although adult guidelines provide definitions for adverse events and levels of severity, they have yet to be adapted to pediatric populations (2,9).…”