Pediatric Considerations in Endoscopic Retrograde Cholangiopancreatography

Troendle, David M.; Barth, Bradley

doi:10.1016/j.giec.2015.08.004

Cited by 32 publications

(29 citation statements)

References 56 publications

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“…ERCP can also provide short-term symptom relief in pediatric patients 56–58 . Sphincterotomy, stent placement and stone removal are the most common therapies.…”

Section: Acute Recurrent and Chronic Pancreatitismentioning

confidence: 99%

Pancreatic Disorders

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Fishman

2017

Pediatric Clinics of North America

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Synopsis Once considered uncommon, pancreatic diseases are increasingly recognized in the pediatric age group. Acute, acute recurrent and chronic pancreatitis occur in children with an incidence approaching that of adults. The risk factors in the pediatric age group are broad, prompting the need for a completely different diagnostic and therapeutic approach in children. Although cystic fibrosis is still the most common cause of exocrine pancreatic insufficiency, other causes such as chronic pancreatitis may be as common as Shwachman Diamond syndrome. Long-term effects of pancreatic diseases may be staggering as children suffer from significant disease burden, high economic cost, nutritional deficiencies, pancreatogenic diabetes and potentially pancreatic cancer.

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“…ERCP can also provide short-term symptom relief in pediatric patients 56–58 . Sphincterotomy, stent placement and stone removal are the most common therapies.…”

Section: Acute Recurrent and Chronic Pancreatitismentioning

confidence: 99%

Pancreatic Disorders

Uç

Fishman

2017

Pediatric Clinics of North America

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“…ERCPs were performed by either adult or pediatric endoscopy specialists. Combined analyses report outcomes comparable to the adult population, 14 although with variable success rates of 70-100%. Children-specific recommendations on minimizing adverse events, which are usually extrapolated from the adult population, 1 may include prophylactic rectal nonsteroidal anti-inflammatory drugs (NSAIDs) or prophylactic pancreatic duct stenting.…”

Section: Introductionmentioning

confidence: 97%

ERCP in infants, children and adolescents is feasible and safe – results from a tertiary care center

et al. 2016

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Background: Indications for endoscopic retrograde cholangiopancreatography (ERCP) in children differ from adults. Paucity of data and concerns about potential lower effectiveness and more side effects limit its use even in high volume centers. We retrospectively analyzed indications, success rates, limitations, and side effects of ERCPs in children <18 years. Methods: From January 2012 to March 2015, 54 ERCPs were performed in 31 children (median age 11 (0-17) years; median weight 22 (3.3-142.7) kg) with suspected choledocholithiasis (n ¼ 13 interventions in 9 patients), post-transplantation anastomotic stenosis (10/4), malignancy (10/5), chronic pancreatitis (7/1), biliary atresia (6/6), anomaly (2/2), leak (4/3), or primary sclerosing cholangitis (PSC) (2/1). All patients were followed up as inpatients. Results: Thirty-six therapeutic and 18 diagnostic procedures were performed by adult ERCP expert endoscopists. Successful intervention was achieved in 90.7% of cases. Failed cannulation (n ¼ 4) was associated with lower body weight (p ¼ 0.023). In children younger than 1 year, ERCP was significantly more often diagnostic than in patients >1 year (p < 0.001). In three of six infants with suspected atresia, surgical exploration was avoided. Five complications were recorded (9.3%), and included four episodes of mild pancreatitis (7.4% post-ERCP pancreatitis (PEP) rate) and one cholangitis in PSC. A trend towards a protective effect of pancreatic stents on PEP was observed. All complications were managed conservatively. No complications were attributed to mechanical stress on the gastrointestinal tract. Conclusions: ERCP in newborns, infants, and adolescents can be safely performed with high technical and clinical success. Endoscopists must be aware of differing spectrum of pediatric diseases. Failed cannulation was associated with lower body weight of young children. Complications were similar to rates reported in adults.

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“…In general, studies on the application of stents in pediatric patients are lacking. However, most pediatric studies of endoscopic retrograde cholangiopancreatography (ERCP), including our previous study, investigated the use of PSs; therefore, stenting is an important indication in pediatric ERCP[ 11 - 13 ]. One pediatric study showed that PS placement was effective for reducing the recurrence of pancreatitis[ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Metal stents placement for refractory pancreatic duct stricture in children

Jeong¹,

Lee²,

Oh³

et al. 2018

WJG

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AIMTo evaluate the use of fully covered self-expandable metal stents (FCSEMSs) for pancreatic duct strictures in children with chronic pancreatitis.METHODSEight patients with refractory benign dominant stricture of the main pancreatic duct (MPD) were enrolled through chart reviews between December 2014 and June 2017 in a single center. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a 6-mm FCSEMS with dual flaps was performed. Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. All procedures were performed by a pediatric gastroenterologist. For the assessment of outcomes, technical and clinical success, adverse events, and stent patency were evaluated retrospectively.RESULTSThe placement and removal of the FCSEMSs were successful in all 8 patients. Five patients were boys and 3 were girls. The median age at initial FCSEMS placement was 12 years (range, 5-18 years). The diameters of all the inserted stents were 6 mm, and the lengths were 4-7 cm. The median indwelling time was 6 mo (range, 3-10 mo). No pancreatic sepsis, pancreatitis, cholestasis, or mortality occurred. There was no proximal and distal migration. All subjects showed a patent stent. On follow-up ERCP, the mean diameter of the stricture improved from 1.1 mm to 2.8 mm (P < 0.05), whereas that of upstream dilation improved from 8.4 mm to 6.3 mm (P < 0.05).CONCLUSIONThis initial experience showed that temporary FCSEMS placement is feasible and safe for the management of refractory benign MPD stricture in children.

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Pediatric Considerations in Endoscopic Retrograde Cholangiopancreatography

Cited by 32 publications

References 56 publications

Pancreatic Disorders

Pancreatic Disorders

ERCP in infants, children and adolescents is feasible and safe – results from a tertiary care center

Metal stents placement for refractory pancreatic duct stricture in children

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