Pediatric ERCP in the Setting of Acute Pancreatitis: A Secondary Analysis of an International Multicenter Cohort Study

Abstract

Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.

Availability and utilization of endoscopic retrograde cholangiopancreatography at children's hospitals

“…This study does not determine when ERCP should be done, but rather reports the associated diagnoses listed in the database. Although a recent systematic literature review suggests ERCP is performed in both adult and pediatric patients for acute pancreatitis, and recent reports suggest ERCP can be performed safely during acute pancreatitis episodes, we cannot distinguish if acute pancreatitis diagnoses may have also been associated with other pancreatic disorders that were not coded, and thus may represent a more complex paradigm of disease 23,24 …”

“…Although a recent systematic literature review suggests ERCP is performed in both adult and pediatric patients for acute pancreatitis, and recent reports suggest ERCP can be performed safely during acute pancreatitis episodes, we cannot distinguish if acute pancreatitis diagnoses may have also been associated with other pancreatic disorders that were not coded, and thus may represent a more complex paradigm of disease. 23,24 After establishing where ERCP was performed, we sought to evaluate factors associated with ERCP utilization among hospitals with "in-house" ERCP availability. Encounters of children with pancreatic disorders who had public insurance, male gender, or were of Black race were less likely to undergo ERCP.…”