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

Abstract

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly utilized procedure in pediatric populations. A lack of dedicated pediatric research has led endoscopists to extrapolate adult risk factors and preventative strategies to children. The aim of this multisite, retrospective study was to identify risks for adverse events, procedure failure, and prolonged courses in pediatric patients undergoing ERCP. Methods: Pediatric patients who had an ERCP at one of our academic centers were identified by query of their electronic medical records. Pre-procedure and post-procedure data were collected with ERCP-related adverse events defined according to the consensus criteria developed by Cotton et al, 2010. Results: Between 1/2004 and 1/2021, 287 children had a total of 716 ERCPs. The procedure success rate was 95.5% with no mortality and an adverse event rate of 12.7%. Younger age was associated with increased case complexity, increased adverse events, and an increased rate of repeat ERCP. Case complexity score correlated with increased procedure time (p < 0.001) and increased adverse events (tau 0.24, p < 0.01), Stent removal and pancreatic stenting were more likely to precede an adverse event. Pancreatitis, pancreatic divisum, and pancreatic stricture/stenosis were associated with increased adverse events and rates of repeat ERCP. Conclusions: Pediatric ERCP adverse event rates are higher than adults. The complexity grading system proposed by the Cotton et al appears to have applicability to pediatric patients. Young age and interventions affecting the pancreatic duct are associated with adverse ERCP outcomes in pediatrics.

ERCP-related Adverse Events in Pediatric Patients: A 10-Years Single-Site Review

“…These data indicate that children who receive repeat ERCP have a signi cantly higher rate of AEs during their initial ERCP compared to the overall average level, suggesting that AEs are more likely to occur during the initial ERCP in children who receive repeat ERCP. This nding is consistent with the conclusions of a multi-center study on factors related to complications of pediatric ERCP [21].…”

“…These data indicate that biliary obstruction is the main indication for pediatric ERCP, while chronic pancreatitis is the primary disease indication for repeat ERCP. A study suggested that pancreatic diseases such as recurrent pancreatitis, chronic pancreatitis, and pancreatic divisum are closely associated with repeat ERCP > 5 times [21].…”