Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study

Abstract

Introduction: The aims of this retrospective multicentre study were to assess the technical success and adverse events of ERCP procedures in children in French and Belgian centres. Methods: All children aged one day to seventeen years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results: 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72% of our patients (340/470). The median age at intervention was 10.9 years. ERCP was therapeutic in 90% (423/470) and diagnostic in cases of neonatal cholestasis in 10% of the patients. The most common biliary indication was choledocholithiasis, and the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92% of cases (270/294); pancreatic cannulation, in 96% (169/176) of cases; and planned therapeutic procedures, in 91% (388/423) of cases. The overall complication rate was 19% (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12% (40/340) and sepsis in 5% (18/340) of cases. In the univariate analyses, pancreatic stent removal was protective against PEP (OR 0.1; 95% CI: 0.01-0.75, p=0.03), and sepsis was associated with liver transplantation history (OR 7.27, 95% CI: 1.7-31.05, p=0.01). Five patients had post-ERCP haemorrhage, and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion: Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

The Efficacy and Safety of Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiography in Pediatric Patients with Surgically Altered Gastrointestinal Anatomy

“…Although the rate of adverse events in the pediatric patients who underwent BEA-ERC was similar to a previous report on ERCP [24], the present study had a significantly higher rate pertaining to adverse events in pediatric patients compared with adult patients, similar to the findings of Mercier et al [24] in pediatric endoscopy. Prolonged procedures increase the risk of developing pancreatitis, while general anesthesia has an added risk for adverse events.…”

“…In a nationwide survey in Japan, Kudo et al [23] reported that pediatric gastrointestinal endoscopies had higher complication rates owing to increasing numbers of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and small intestine enteroscopy. The study by Mercier et al [24] of 15 French and Belgian centers reported a 19% adverse event rate for pediatric patients undergoing ERCP. However, the feasibility and safety of BEA-ERC in pediatric patients have not been established.…”

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children

“…Pediatric gastroenterologists independently implemented ERCP in 31% of facilities and EUS in only 5% of facilities. 4 Relatively large-scale studies over the past 5 years show that the number of ERCP and EUS procedures per year ranges from 1-92 and 4-19, respectively, as shown in Table 2 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and Table 3. [22][23][24][25][26][27][28] In addition, these procedures were performed by pediatric gastroenterologists in limited institutions.…”

“…A DVERSE EVENTS OF ERCP and EUS in children are almost similar to those in adults, including post-ERCP pancreatitis (PEP), gastrointestinal perforation, biliary tract infections, and bleeding. 5,[76][77][78] Most studies of ERCP-related complications in children have been retrospective and have insufficient data to analyze them. This highlights the need for large prospective studies to evaluate the effectiveness of methods of preventing complications.…”

“…One of the major complications of ERCP is PEP, which occurs in children with a frequency of 5-12%. 5,17,21,69,[79][80][81] Iqbal et al reported that pancreatitis was more frequent in therapeutic ERCP than diagnostic ERCP, and had an overall frequency of 2.5%. 82 In order to prevent PEP, it is necessary to understand known risk factors and take preventive measures for PEP.…”