Ercp in Infants, Children, and Adolescents – Different Roles of the Methods in Different Age Groups

Keil, Radan; Drábek, Jir̆ı́; Lochamnnová, J; Šťovíček, Jan; Koptová, Petra; Wasserbauer, Martin; Frýbová, Barbora; Šnajdauf, J; Rygl, Michal; Kotalova, Radana; Hlava, Štěpán

doi:10.1055/s-0039-1681724

Cited by 5 publications

(11 citation statements)

References 13 publications

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“…The complication rate of ERCP in children is around 10 % [3]. Our pooled complication rate was similar to that in previous re-ports [18,21].…”

Section: Discussionsupporting

confidence: 86%

“…Technical success for diagnostic and therapeutic ERCP in children is high, as in adults [8,18]. In children, ERCP should be more challenging, but complication rates in studies are similar to those reported in adults when performed by expert endoscopists [4].…”

Section: Discussionmentioning

confidence: 94%

“…The therapeutic role of ERCP is limited in infants, given that the pediatric duodenoscope from Olympus, with its metal tip (▶ Fig. 1) and small working channel, cannot be used for papillary sphincterotomy and choledocholithiasis must be resolved by insertion of a temporary biliary stent without papillary sphincterotomy [3]. The production of pediatric endoscopes is in question and this may complicate future diagnosis and therapeutic care in the pediatric population [3].…”

Section: Discussionmentioning

confidence: 99%

“…This may be because of the infrequent indications in children and a lack of data concerning its outcomes and complications. Several cohorts of children who have undergone ERCP have been described, but few of these have been in European countries [3].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…The complication rate of ERCP in children is around 10 % [3]. Our pooled complication rate was similar to that in previous re-ports [18,21].…”

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Several centers no longer have an infant ERCP duodenoscope due to breakdowns and wear [ 15 ]. If the production of these endoscopes is not restored, the diagnostic and therapeutic role of ERCP in neonates and infants will be endangered [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Conjugated Hyperbilirubinemia in Infants: Is There Still a Role for ERCP?

Šťovíček

Hlava

Keil

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Over a twenty-year period, we performed 255 ERCP procedures in infants aged up to 1 year. ERCP was indicated in cholestatic infants with suspicion of biliary obstruction. The most common diagnosis was biliary atresia (48%), choledochal cysts (13%), and choledocholithiasis (4%). The procedure complication rate was 13.7%. Hyperamylasemia occurred in 12.9%. More severe complications were rare‐0.8% of ERCP procedure. There were no cases of postprocedural pancreatitis or death. Our study has proved that ERCP is a safe and reliable method in this age group. Its high specificity and negative predictive value for extrahepatic biliary atresia can prevent unnecessary surgeries in patients with normal bile ducts or endoscopically treatable pathologies.

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Endoscopic retrograde cholangiopancreatography in infants and children

Åvitsland

Aabakken

2021

Endosc Int Open

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Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

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Ercp in Infants, Children, and Adolescents – Different Roles of the Methods in Different Age Groups

Cited by 5 publications

References 13 publications

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

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

Conjugated Hyperbilirubinemia in Infants: Is There Still a Role for ERCP?

Endoscopic retrograde cholangiopancreatography in infants and children

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