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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E292-E296
DOI: 10.1055/a-1337-2212
Original article

Endoscopic retrograde cholangiopancreatography in infants and children

Tone Lise Åvitsland
1   Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Lars Aabakken
1   Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
2   Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Abstract

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.



Publication History

Received: 11 May 2020

Accepted: 19 November 2020

Article published online:
18 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Keil R, Drabek J, Lochmannova J. et al. ERCP in infants, children, and adolescents-Different roles of the methods in different age groups. PLoS One 2019; 14: e0210805
    CrossrefPubMedGoogle Scholar
  • 2 Rosen JD, Lane RS, Martinez JM. et al. Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 2017; 52: 1148-1151
    CrossrefPubMedGoogle Scholar
  • 3 Kohoutova D, Tringali A, Papparella G. et al. Endoscopic treatment of chronic pancreatitis in pediatric population: Long-term efficacy and safety. United European Gastroenterol J 2019; 7: 270-277
    CrossrefPubMedGoogle Scholar
  • 4 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
    CrossrefPubMedGoogle Scholar
  • 5 Aabakken L, Aagenaes I, Sanengen T. et al. Utility of ERCP in neonatal and infant cholestasis. J Laparoendosc Adv Surg Tech A 2009; 19: 431-436
    CrossrefPubMedGoogle Scholar
  • 6 Troendle DM, Barth BA. Pediatric considerations in endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am 2016; 26: 119-136
    CrossrefPubMedGoogle Scholar
  • 7 Shanmugam NP, Harrison PM, Devlin J. et al. Selective use of endoscopic retrograde cholangiopancreatography in the diagnosis of biliary atresia in infants younger than 100 days. J Pediatr Gastroenterol Nutr 2009; 49: 435-441
    CrossrefPubMedGoogle Scholar
  • 8 Keil R, Snajdauf J, Rygl M. et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates -- a retrospective study on a large series. Endoscopy 2010; 42: 121-126
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Petersen C, Meier PN, Schneider A. et al. Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia. J Hepatol 2009; 51: 1055-1060
    CrossrefPubMedGoogle Scholar
  • 10 Giefer MJ, Kozarek RA. Technical outcomes and complications of pediatric ERCP. Surg Endosc 2015; 29: 3543-3550
    CrossrefPubMedGoogle Scholar
  • 11 Usatin D, Fernandes M, Allen IE. et al. Complications of endoscopic retrograde cholangiopancreatography in pediatric patients; a systematic literature review and meta-analysis. J Pediatr 2016; 179: 160-5 e3
    CrossrefPubMedGoogle Scholar
  • 12 Felux J, Sturm E, Busch A. et al. ERCP in infants, children and adolescents is feasible and safe: results from a tertiary care center. United European Gastroenterol J 2017; 5: 1024-1029
    CrossrefPubMedGoogle Scholar
  • 13 Kieling CO, Hallal C, Spessato CO. et al. Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience. World J Pediatr 2015; 11: 154-159
    CrossrefPubMedGoogle Scholar
  • 14 Committee AT, Barth BA, Banerjee S. et al. Equipment for pediatric endoscopy. Gastrointest Endosc 2012; 76: 8-17
    CrossrefPubMedGoogle Scholar