Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study

Abstract

Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers.

Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included.

Results 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 – 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 – 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality.

Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

• References

• 1 Keane MG, Kumar M, Cieplik N. et al. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr 2018; 09: 42
• 2 Waye JD. Endoscopic retrograde cholangiopancreatography in the infant. Am J Gastroenterol 1976; 65: 461-463
• 3 Keil R, Drábek J, Lochmannová J. et al. ERCP in infants, children, and adolescents-Different roles of the methods in different age groups. PLoS ONE 2019; 14: 0210805
• 4 Varadarajulu S, Wilcox CM, Hawes RH. et al. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004; 60: 367-371
• 5 Thomson M, Tringali A, Dumonceau J-M. et al. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64: 133-153
• 6 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 7 Cotton PB, Eisen G, Romagnuolo J. et al. Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc 2011; 73: 868-874
• 8 Dike CR, Zimmerman B, Zheng Y. et al. Clinical and practice variations in pediatric acute recurrent or chronic pancreatitis: report from the INSPPIRE study. J Pediatr Gastroenterol Nutr 2020; 71: 112-118
• 9 Shanmugam V, Beattie GC, Yule SR. et al. Is magnetic resonance cholangiopancreatography the new gold standard in biliary imaging?. Br J Radiol 2005; 78: 888-893
• 10 Dong C, Zhu H-Y, Chen Y-C. et al. Clinical assessment of differential diagnostic methods in infants with cholestasis due to biliary atresia or non-biliary atresia. Curr Med Sci 2018; 38: 137-143
• 11 Keil R, Snajdauf J, Stuj J. et al. Endoscopic retrograde cholangiopancreatography in infants and children. Indian J Gastroenterol 2000; 19: 175-177
• 12 Wang Q, Moon SB, Zang J. et al. Usefulness of pre-operative endoscopic retrograde cholangiopancreatography in diagnosis and management of forme fruste choledochal cyst in children. ANZ J Surg 2020; 90: 1041-1045
• 13 Vegting IL, Tabbers MM, Taminiau J. et al. Is endoscopic retrograde cholangiopancreatography valuable and safe in children of all ages?. J Pediatr Gastroenterol Nutr 2009; 48: 66-71
• 14 Poddar U, Thapa BR, Bhasin DK. et al. Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol 2001; 16: 927-931
• 15 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
• 16 Wen J, Li T, Liu L. et al. Long-term outcomes of therapeutic ERCP in pediatric patients with pancreas divisum presenting with acute recurrent or chronic pancreatitis. Pancreatology 2019; 19: 834-841
• 17 Liu QY, Gugig R, Troendle DM. et al. The roles endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the evaluation and treatment of chronic pancreatitis in children: a position paper from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2020; 70: 681-693
• 18 Keil R, Drábek J, Lochmannová J. et al. ERCP in infants, children, and adolescents–Different roles of the methods in different age groups. PLoS One 2019; 17: 14
• 19 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
• 20 Saito T, Terui K, Mitsunaga T. et al. Role of pediatric endoscopic retrograde cholangiopancreatography in an era stressing less-invasive imaging modalities. J Pediatr Gastroenterol Nutr 2014; 59: 204-209
• 21 Giefer MJ, Kozarek RA. Technical outcomes and complications of pediatric ERCP. Surg Endosc 2015; 29: 3543-3550
• 22 Shah R, Cohen RZ, Mekaroonkamol P. et al. Retrospective multicenter matched controlled comparison of endoscopic retrograde cholangiopancreatography in pediatric patients: a 10-year experience. J Pediatr Gastroenterol Nutr 2020; 70: 568-573
• 23 Troendle DM, Abraham O, Huang R. et al. Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population. Gastrointest Endosc 2015; 81: 1408-1416
• 24 Troendle DM, Gurram B, Huang R. et al. IV ibuprofen for prevention of post-ERCP pancreatitis in children: a randomized placebo-controlled feasibility study. J Pediatr Gastroenterol Nutr 2020; 70: 121-126
• 25 Goetz M, Andersen P, Bergman J. et al. ERCP in babies: Low risk of post-ERCP pancreatitis - results from a multicentre survey. United European Gastroenterol J 2020; 8: 77-80
• 26 Dumonceau J-M, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-149
• 27 Lange B, Adam R, Kähler G. et al. Experience with stent placement for benign pancreaticobiliary disorders in children. J Laparoendosc Adv Surg Tech A 2019; 29: 839-844
• 28 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
• 29 Enestvedt BK, Tofani C, Lee DY. et al. Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious. J Pediatr Gastroenterol Nutr 2013; 57: 649-654
• 30 Uc A, Fishman DS. Pancreatic disorders. Pediatr Clin North Am 2017; 64: 685-706
• 31 Fishman DS, Giefer MJ, Barth B. et al. Digital evaluation of the biliopancreatic tree: cases from the pediatric ERCP Database Initiative Consortium. J Pediatr Gastroenterol Nutr 2017; 64: 125