Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative

Abstract

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs. Methods: In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week postprocedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events. Results: A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified. Conclusions: This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.

Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children

“…The dilatation of the common bile duct and common duct stones in these patients increases the risk and should indicate the need for ERCP [ 28 ]. ERCP reduces common bile duct explorations during surgery but is associated with a 5–10% complication risk [ 29 , 30 , 31 ]. In adults, total bilirubin > 4 mg/dL and common bile duct (CBD) dilatation > 6 mm are indicative of a recommendation for preoperative ERCP [ 32 , 33 ].…”

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

“…This study utilized the complexity scoring system previously proposed by Cotton et al (11). This is an important risk stratification tool for adults undergoing ERCP, though this has only recently been utilized for pediatric patients (13). Here, as might be expected, a significant increase in procedure times and adverse events was seen with increasing case complexity.…”

Endotherapy in pediatric pancreatitis

“…Post-ERCP pancreatitis (PEP) was the only reported adverse event in two cases [10]. Success rates from the PEDI database in this age group are not as promising (76% successful cannulation) and increased risk for PEP has been observed underscoring the need for continued collaboration with industry to develop equipment and duodenoscopes that cater to this vulnerable population and allow for increased safety and technical success [6 ▪ ].…”

“…Post-ERCP pancreatitis is the most common adverse for all ERCP in adults and children. The complication is directly related to cannulation and manipulation of the pancreatic duct which likely explains the increased risk seen in children with a history of ARP and CP [6 ▪ ]. Fluoroscopy time has also been shown to be increased in children with CP who undergo ERCP, which carries a potentially higher risk of long-term malignancy years after the procedure [14 ▪ ].…”

“…As imaging modalities have improved in diagnosing features of chronic pancreatitis, ERCP is utilized less in children for diagnosis and now primarily employed for therapeutic indications (or diagnostic procedures where therapy is also anticipated). Twenty-seven percent of all ERCPs in children reported in the PEDI database were done for a pancreatic indication, with the majority undertaken to improve pancreatic drainage in patients with CP [6 ].…”