DOI QR코드

DOI QR Code

Endoscopic Retrograde Cholangiopancreatography in Children: Feasibility, Success, and Safety with Standard Adult Endoscopes and Accessories

  • Received : 2021.12.29
  • Accepted : 2022.07.20
  • Published : 2022.09.15

Abstract

Purpose: The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary and pancreatic diseases in the pediatric population was not well defined until recently. Our aim was to determine the feasibility, outcomes, and safety of ERCP in a local pediatric population, particularly using standard adult endoscopes and accessories. Methods: This retrospective study was conducted at the National Hospital of Sri Lanka. Pediatric patients (aged <16 years) who underwent ERCP from January 2015 to December 2020 were included in the study. Data, including patient demographics, indications for the procedure, technical details, and associated complications, were collected from the internal database and patient records maintained at the hospital. Results: The study included 62 patients who underwent a total of 98 ERCP procedures. All the procedures were performed by adult gastroenterologists using standard adult endoscopes and accessories. The mean age was 11.01±3.47 years. Pancreatic diseases were the major indications for most of the procedures (n=81, 82.7%), with chronic pancreatitis being the most common. Seventeen procedures (17.3%) were carried out for biliary diseases. Overall cannulation and technical success rates were 87.8% and 85.7%, respectively. Stent placement was the most common therapeutic intervention (n=66; 67.4%). Post-ERCP pancreatitis was the most common complication, occurring in eight patients (8.2%). Conclusion: ERCP can be successfully and safely performed in pediatric populations using standard adult endoscopes and accessories with complications similar to those of adults. Adult ERCP services can be offered to most pediatric patients without additional costs of pediatric endoscopes and accessories.

Keywords

References

  1. Kozarek RA. The past, present, and future of endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol (N Y) 2017;13:620-2.
  2. Fox VL, Werlin SL, Heyman MB. Endoscopic retrograde cholangiopancreatography in children. Subcommittee on Endoscopy and Procedures of the Patient Care Committee of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2000;30:335-42. https://doi.org/10.1097/00005176-200003000-00025
  3. Dahale AS, Puri AS, Sachdeva S, Srivastava S, Kumar A. Endoscopic retrograde cholangiopancreaticography in children: a single-center experience from Northern India. Indian Pediatr 2019;56:196-8. https://doi.org/10.1007/s13312-019-1498-2
  4. Felux J, Sturm E, Busch A, Zerabruck E, Graepler F, Stuker D, et al. ERCP in infants, children and adolescents is feasible and safe: results from a tertiary care center. United European Gastroenterol J 2017;5:1024-9. https://doi.org/10.1177/2050640616687868
  5. Keane MG, Kumar M, Cieplik N, Thorburn D, Johnson GJ, Webster GJ, et al. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr 2018;18:42.
  6. Agarwal J, Reddy DN, Talukdar R, Lakhtakia S, Ramchandani M, Tandan M, et al. ERCP in the management of pancreatic diseases in children. Gastrointest Endosc 2014;79:271-8. https://doi.org/10.1016/j.gie.2013.07.060
  7. Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014;46:799-815. https://doi.org/10.1055/s-0034-1377875
  8. Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCPrelated adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:127-49. https://doi.org/10.1055/a-1075-4080
  9. Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children. World J Gastroenterol 2010;16:490-5. https://doi.org/10.3748/wjg.v16.i4.490
  10. Yildirim AE, Altun R, Ocal S, Kormaz M, Ozcay F, Selcuk H. The safety and efficacy of ERCP in the pediatric population with standard scopes: does size really matter? Springerplus 2016;5:128.
  11. Limketkai BN, Chandrasekhara V, Kalloo AN, Okolo PI 3rd. Comparison of performance and safety of endoscopic retrograde cholangiopancreatography across pediatric age groups. Dig Dis Sci 2013;58:2653-60. https://doi.org/10.1007/s10620-013-2691-0
  12. Rosen JD, Lane RS, Martinez JM, Perez EA, Tashiro J, Wagenaar AE, et al. Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 2017;52:1148-51. https://doi.org/10.1016/j.jpedsurg.2017.01.051
  13. Sheppard DP, Craddock SJ, Warner BD, Wilkinson ML. ERCP cannulation success benchmarking: implications for certification and validation. Frontline Gastroenterol 2015;6:141-6. https://doi.org/10.1136/flgastro-2014-100473
  14. ASGE Standards of Practice Committee, Lightdale JR, Acosta R, Shergill AK, Chandrasekhara V, Chathadi K, et al. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 2014;79:699-710. https://doi.org/10.1016/j.gie.2013.08.014
  15. Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017;49:83-91.
  16. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47. https://doi.org/10.1016/j.gie.2016.06.051