Endoscopic Retrograde Cholangiopancreatography in Children:A Surgeon’s Perspective
By Pascale Prasil, Jean-Martin Laberge, Alan Barkun, and He´le`ne Flageole
The aim of this study was to review the indications,success rate, and complications of endoscopic retrogradecholangiopancreatography (ERCP) in the pediatric agegroup.
From 1990 to 1999, 21 ERCP procedures wereattempted in 20 patients. They consisted of 8 boys and 12girlswhoseagerangedfrom4to17years(mean,11.3years).Fourteen were performed under deep sedation (mean age,12.8 years), and 7 were done under general anesthesia(mean age, 7.6 years). All ERCP procedures were performedby experienced adult endoscopists.
The indication for ERCP was biliary in 15 patients.Eleven had suspected choledocholithiasis by either ultra-sound scan, intraoperative cholangiogram or magnetic res-onance imaging (MRI). In 6 cases, the ERCP was done forpancreatic pathology. In 11 patients, the ERCP was diagnos-tic only, and in 10 a therapeutic procedure was done. Theoverall success rate was 90.5%. Post-ERCP complicationsconsisted of 6 episodes of pancreatitis (28.5%), 4 of whichfollowed a therapeutic procedure, and 1 episode of bleeding.Pancreatitis resolved 2 to 6 days post-ERCP. The patientsunderwent follow-up between 2 and 56 months after theERCP (mean, 11 months).
The authors conclude that even in experi-enced hands, ERCP in the pediatric population has a muchhigher complication rate than in adults (33.3%). We rec-ommend that very speciﬁc indications be met before sub- jecting a pediatric patient to an endoscopic retrogradecholangiopancreatography.
J Pediatr Surg 36:733-735. Copyright
2001 by W.B.Saunders Company.
INDEX WORDS: Endoscopic retrograde cholangiopancre-atography, complications.
NDOSCOPIC retrograde cholangiopancreatography(ERCP) has been used increasingly in the pediatricpopulation over the last 10 years both as a diagnostic andtherapeutic modality. Several small and very few largerseries have been published on ERCP in children. Theyreport success and complication rates comparable withthose quoted in the adult literature.
After encounteringseveral cases of pancreatitis after ERCP, some that weredone for suspected rather then proven common bile duct(CBD) stones, we reviewed the experience with ERCP atthe Montreal Children’s Hospital (MCH) to examine ourindications, success rate, and complications in compari-son with those of other series, and to determine whetherour indications should be revised.
MATERIALS AND METHODS
We reviewed retrospectively the charts of all patients who underwentan ERCP from 1990 to 1999. Twenty-one ERCP procedures wereundertaken in 20 patients, comprising 8 boys and 12 girls whose agesranged from 4 to 17 years (mean, 11.3 years). The indications, results,and complications were noted as well as the type of anesthesia used.The latter was decided according to the age of the patient and expectedcooperation. The 7 youngest patients (mean age, 7.6 years) were treatedunder general anesthesia in the interventional radiology suite with theassistance of a pediatric anesthetist, whereas the 14 older teenagers(mean age, 12.8 years) were given sedation. All ERCP procedures,whether diagnostic or therapeutic, were performed by a very experi-enced adult endoscopist using an adult gastroduodenoscope. In thecomplications, pancreatitis was deﬁned as abdominal pain post-ERCPassociated with any elevation of the pancreatic enzymes (amylase andlipase).
The two main indications for ERCP were biliarypathology in 15 cases and pancreatic pathology in 6cases. In the biliary group, 11 patients had suspected orproven common bile duct (CBD) stones, and 3 patientshad unexplained biliary tract dilatation by either ultra-sound scan, magnetic resonance imaging (MRI), or in-traoperative cholangiogram. The 15th patient had theexamination done to rule out sclerosing cholangitis. Theﬁndings at ERCP in this biliary pathology group were 9common bile duct stones, 3 normal examinations, 1 CBDstricture, 1 choledochal cyst, and 1 patient in whom theCBD could not be cannulated. For the 9 patients with
From the Division of General Pediatric Surgery, Montreal Chil-dren’s Hospital, McGill University Health Center, Montreal, Quebec,Canada.Presented at the 32nd Annual Meeting of the Canadian Associationof Paediatric Surgeons, Chaˆteau Montebello, Quebec, Canada, Sep-tember 15-18, 2000. Address reprint requests to He´le`ne Flageole, MD, FRCS(C), FACS, Montreal Children’s Hospital, 2300 Tupper St, Room C-1129, Mon-treal, Quebec, Canada H3H 1P3.Copyright © 2001 by W.B. Saunders Company0022-3468/01/3605-0014$35.00/0doi:10.1053/jpsu.2001.22948
Journal of Pediatric Surgery,
Vol 36, No 5 (May), 2001: pp 733-735