Diagnostic and therapeutic ERCP in the pediatric age group

Abstract

The role and value of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric age group is not well established, because pancreatic and biliary diseases are less common in children. This however is not the case in areas like the Eastern Province of Saudi Arabia where sickle cell disease (SCD) and other hemoglobinopathies are common, with increased frequency of cholelithiasis and choledocholithiasis. The purpose of this study was to evaluate the indications, findings, safety and therapies of ERCP in children. One hundred and twenty five children had diagnostic and/or therapeutic ERCP as part of their management at our hospital. Their medical records were reviewed for: age at diagnosis, sex, Hb electrophoresis, indication for ERCP, findings, therapy and complications. There were 77 males and 48 females. Their age at presentation ranged from 5-18 year (mean 13.25 year). The majority of them had sickle cell disease (77.6%). The indications for ERCP were: obstructive jaundice (67.2%), recurrent biliary colic with or without jaundice (10.4%), acute and chronic pancreatitis (7.2%), postoperative bile leak (2.4%), cholangitis with obstructive jaundice (2.4%), hepatitis of unknown etiology (3.2%), cirrhosis of unknown etiology (4%), thalassemia with jaundice (0.8%), hemobilia (0.8%), acute cholecystitis with jaundice (0.8%), and sickle cell disease with ulcerative colitis and obstructive jaundice (0.8%). In six children, ERCP was done following laparoscopic cholecystectomy. ERCP was carried out under sedation in 91 (72.8%) children and under general anesthesia in 34. It was successful in 121 (96.8%) children while cannulation of the Ampulla failed in four. ERCP was normal in 43 children, but eight of them showed evidence of recent stone passage and in six, there were gallstones. In the remaining children, ERCP revealed: normal CBD with stones (18 patients), dilated CBD with stones (17 patients), dilated CBD without stones (19 patients), dilated biliary tree with stones (10 patients), dilated biliary tree without stones (six patients), bile leak (two patients), dilated biliary tree with stones and choledocho-duodenal fistula (one patient), choledochal cyst (two patients), septate gallbladder (one patient), normal ERCP with multiple pancreatic cysts (one patient) and biliary stricture (one patient). The following procedures were carried out: 35 had endoscopic sphincterotomy and stone extraction, 20 had endoscopic sphincterotomy, four had CBD stenting, one underwent removal of a stent, two had insertion of a nasobiliary tube and one had biliary endoprosethesis. There was no mortality. One had bleeding from the site of sphincterotomy which stopped after adrenaline injection. Four patients (3.2%) developed transient mild pancreatitis which settled conservatively. ERCP in the pediatric age group is safe both as a diagnostic and therapeutic procedure. ERCP can provide valuable information which aid in the diagnosis of biliary and pancreatic diseases in children as well as therapy with the technical feasibility of ...

Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population

“…Recent pediatric case reviews which incorporate higher proportions of ERCPs performed for pancreatic indications as well as those requiring therapeutic interventions have reported rates of PEP ranging from 2.5% to 9.4%. [12][13][14][15] These rates of PEP are similar to the 1% to 7% commonly cited in the adult literature, which has been more rigorously studied. 16 The rate of PEP experienced in this study (10.9%) is Acute leukoencephalopathy developed during admission, which was also managed only slightly outside these previously reported rates, with mild variations likely related to case mix, operator characteristics, and variations in post-ERCP management.…”

Safety and long-term outcomes of endoscopic papillary balloon dilation in children with bile duct stones

“…7,8 With regard to the endoscopic procedure, endoscopic sphincterotomy (EST) has been performed for the treatment of BDSs even in pediatric patients, despite possible complications including hemorrhage, pancreatitis, and perforation. 7,[9][10][11] Endoscopic papillary balloon dilation (EPBD), which was first reported in 1983, 12 has the advantages of preserving sphincter of Oddi function and having a lower risk of hemorrhage and perforation compared with EST. 13,14 These advantages raise the possibility that EPBD may be an alternative to EST in the treatment strategy for pediatric patients with BDSs.…”

Management of the Pediatric Patient with Choledocholithiasis in an Era of Advanced Minimally Invasive Techniques

“…9 The success rate of ERCP, defined as successfully cannulating the ampula, ranges between 89% and 97%. 10,11 In the hands of a skilled endoscopist, the estimated complication rate for ERCP in children is 3%-5%. 11,12 The most frequently described complication is post-ERCP pancreatitis.…”