ERCP in the evaluation of abdominal pain in children

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.

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“…Fourteen of the 32 studies were conducted in the US (4–6, 13–16, 25–31). All 32 of the studies were from referral centers.…”

Section: Resultsmentioning

confidence: 99%

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

Usatin

Fernandes

Allen

et al. 2016

The Journal of Pediatrics

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“…In addition, ERCP usually conducted in tertiary centres where the majority of the ERCPs are performed by one experienced operator. [18]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the use of laparoscopic-guided cholecystocholangiography and liver biopsy in definitive diagnosis of neonatal cholestatic jaundice

Shreef

Al-Helal

2016

Afr J Paediatr Surg

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Background:Once it is established that a jaundiced infant has direct hyperbilirubinemia, the principal diagnostic concern is to differentiate hepatocellular from obstructive cholestasis. Traditional tests such as ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary iminodiacetic acid (HIDA) scan are often not sufficiently discriminating. Definitive exclusion of biliary atresia (BA) in the infant with cholestatic jaundice usually requires mini-laparotomy and intra-operative cholangiography. This approach has many drawbacks because those sick infants are subjected to a time-consuming procedure with the probability of negative surgical exploration.Aim of the Study:The aim of this study was to determine the feasibility of laparoscopic-guided cholecystocholangiography (LGCC) and its accuracy and safety in the diagnosis of BA and thus preventing unnecessary laparotomy in infants whose cholestasis is caused by diseases other than BA.Patients and Methods:Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 7–98 days; mean, 56 days) after ultrasound scan and (99 mTc) HIDA scan and percutaneous liver biopsy failed to provide the definitive diagnosis.Results:One patient had completely absent gall bladder (GB) so the laparoscopic procedure was terminated and laparotomy was done (Kasai operation). Four patients had small size GB; they underwent LGCC that showed patent common bile duct with atresia of common hepatic duct, so laparotomy and Kasai operation was performed. Seven patients had well-developed GB, LGCC revealed patent biliary tree, so laparoscopic liver biopsies were taken for histopathology. Five of those patients had neonatal hepatitis, and two had cholestasis as a complication of prolonged TPN. No perioperative complications or mortalities were recorded.Conclusion:When the diagnosis neonatal cholestasis remains elusive after traditional investigations, LGCC is an accurate and simple method for differentiating BA from hepatocellular causes.

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure indicated for the diagnosis and treatment of biliary tree and pancreatic pathologies in adults and children [ 1 , 2 ]. Since there is limited information about this procedure in children, there are no requirements for its performance and maintenance established by the guidelines of the American Society for Gastrointestinal Endoscopy, so the same indications are used as in adults [ 3 - 6 ]. This may be related to the limited experience in pediatric patients and the fact that the data found in the literature describe a small number of patients, which has been associated with the lack of a defined consensus on its indications, safety profile, success rate, and complication rate [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has been seen that patients between one year of age and adolescents have successful cannulation in 95% of the procedures; in neonates, the data are very different, varying between 27% and 95%, being the duodenal malrotation and the inability of the professional to achieve cannulation the limitations for the procedure to be effective [ 8 ]. The most important reported complications are pancreatitis, infections, bleeding, and perforation [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in Children: Nine Years' Experience at Santa Fe Foundation in Bogota, Colombia

Gómez¹,

Ceballos²,

Rozo³

et al. 2023

Cureus

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Introduction: Experience in the use of diagnostic and/or therapy of endoscopic retrograde cholangiopancreatography (ERCP) in children is limited. This is due to the underdiagnosis of pancreaticobiliary disease in the pediatric population and specialist personnel in this procedure. Objective: To determine the safety and success rate of ERCP in children at Hospital Fundación Santa Fe de Bogotá between January 2007 and June 2015. Methodology: This was an observational, descriptive, retrospective case series study of patients under 18 years, who underwent ERCP between January 2007 and June 2015. The following variables were analyzed: indication, duration, type of procedure, rate of success, and complications. Results: A total of 30 patients were included, in whom 65 ERCP procedures were performed. Successful cannulation was achieved in 52 of the 65 procedures (80%). Among the complications that occurred, there were four cases of pancreatitis (6.2%), two cases of bleeding (3.1%), and one case of bacteremia (1.5%), and in most cases (58 in total, 89.2%), there were no complications. Discussion: The pediatric gastroenterology group of the Fundación Santa Fe de Bogotá has obtained good results in performing ERCP in the pediatric population with a success rate of 80% associated with a null mortality rate. There is enough literature available to conclude that performing ERCP in the pediatric population maintains an adequate success rate and a low complication rate. In all the studies evaluated, a null mortality rate was found, so it is considered that this procedure is safe in patients under 18 years of age.

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ERCP in the evaluation of abdominal pain in children

Cited by 9 publications

References 19 publications

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

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

Evaluation of the use of laparoscopic-guided cholecystocholangiography and liver biopsy in definitive diagnosis of neonatal cholestatic jaundice

Endoscopic Retrograde Cholangiopancreatography in Children: Nine Years' Experience at Santa Fe Foundation in Bogota, Colombia

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