Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) in Children and Adolescents: Experience in a Single Institution

Abstract

Introduction: Experience in the use of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of pancreaticobiliary disorders is relatively limited in children. This report reviews the experience in a single institution with pediatric ERCPs and documents the indications, success rate, diagnostic and therapeutic yields, complications, and the impact on patient management. Patients and Methods: The data of all consecutive patients aged ≤ 18 years who underwent ERCP procedures between the years 1997 and 2007 were retrospectively identified through a computer database search. The database prospectively recorded the indications, findings, therapies, and complications. Results: During the study period, 32 ERCP procedures were performed in 28 children with a median age of 13 (range 8 – 18) years. ERCPs were performed for biliary pathology in 21 (75 %) and for pancreatic pathology in 7 (25 %) patients. The most common biliary indications were suspected choledocholithiasis and postoperative bile leaks. Hydatid disease was the most common diagnosis that yielded bile leaks. The pancreatic indications were recurrent pancreatitis and traumatic pancreatic duct disruption. Cannulation of the desired duct was successful in all procedures. An endoscopic sphincterotomy, stone/sludge removal or a stent placement was performed in 20 (63 %) procedures. According to the long-term follow-up, avoidance from any further surgical interventions was achieved in 11 (65 %) children, in whom ERCP was undertaken as a therapeutic intervention. The complication rate was 6 % with the development of mild self-resolving pancreatitis in one patient and stent occlusion in another. Conclusions: ERCP in the pediatric population has a high success rate, both as a diagnostic tool and for therapeutic interventions, provided it is performed by experienced endoscopists. The delicate delineation of the anatomy by ERCP and its therapeutic potential make it absolutely superior to other less invasive tools such as magnetic resonance cholangiopancreatography.

Key words

ERCP - biliary - pancreatic - hydatid - children

References

• 1 Bilsel Y, Bulut T, Yamaner S, Buyukuncu Y, Bugra D, Akyuz A, Sokucu N. ERCP in the diagnosis and management of complications after surgery for hepatic echinococcosis.  Gastrointest Endosc. 2003;  50 210-213
• 2 Cay A, Imamoglu M, Bektas O, Ozdemir O, Arslan M, Sarihan H. Nonoperative treatment of traumatic pancreatic duct disruption in children with an endoscopically placed stent.  J Pediatr Surg. 2005;  40 E9-E12
• 3 Durakbasa C U, Sander S, Sehiralti V, Tireli G A, Tosyali A N, Mutus M. Pulmonary hydatid disease in children: outcome of surgical treatment combined with perioperative albendazole therapy.  Pediatr Surg Int. 2006;  22 173-178
• 4 Fox V L, Werlin S L, Heyman M B. Endoscopic retrograde cholangiopancreatography in children.  J Pediatr Gastroenterol Nutr. 2000;  30 335-342
• 5 Iscan M, Duren M. Endoscopic sphincterotomy in the management of postoperative complications of hepatic hydatid disease.  Endoscopy. 1991;  23 282-283
• 6 Pfau P R, Chelimsky G G, Kinnard M F, Sivak M V, Wong R CK, Isenberg G A, Gurumurthy P, Chak A. Endoscopic retrograde cholangiopancreatography in children and adolescents.  J Pediatr Gastroenterol Nutr. 2002;  35 619-623
• 7 Rocca R, Castellino F, Daperno M, Masoero M, Sostegni R, Ercole E, Lavagna A, Barbera C, Canavese F, Pera A. Therapeutic ERCP in pediatric patients.  Dig Liver Dis. 2005;  37 357-362
• 8 Samavedy R S, Sherman S, Lehman G A. Endoscopic therapy in anomalous pancreatobiliary duct junction.  Gastrointest Endosc. 1999;  50 623-627
• 9 Simsek H, Ozaslan E, Sayek I, Savas C, Abbasoglu O, Soylu A R, Balaban Y, Tatar G. Diagnostic and therapeutic ERCP in hepatic hydatid disease.  Gastrointest Endosc. 2003;  58 384-389
• 10 Teng R, Yokohata K, Utsunomiya N, Takahata S, Nabae T, Tanaka M. Endoscopic retrograde cholangiopancreatography in infants and children.  J Gastroenterol. 2000;  35 39-42
• 11 Testoni P A, Caporuscio S, Bagnolo F, Lella F. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment.  Am J Gastroenterol. 2000;  95 1702-1707