Diagnostic and therapeutic ERCP in children: Safe with a high success rate in experienced hands

Abstract

DIAGNOSTIC AND THERAPEUTIC ERCP IN CHILDREN: SAFE WITH A HIGH SUCCESS RATE IN EXPERIENCED HANDS Portwoed, A Maniatis, PS Jowell, MS Branch, J Affronti, S Guarisco, J Leung, PB Cotton, J Balliie, Division of Gastroenterology, Duke University Medical Center, Durham, NC Concern regarding the safety and success of diagnostic and therapeutic ERCP in children may limit the use of these potentially valuable interventions. Objective: To review the safety and success of diagnostic and therapeutic ERCP in children. Methods: A retrospective analysis of our database from 1988 1994. Results: 36 ERCPs were performed on 26 patients (13 male, 13 female) aged 3-18 years (median 13 years). 22 procedures were performed with general anesthesia and 14 with conscious sedation. A standard adult duodenoscope was used in all eases. Indications included recurrent idiopathic pancreatitis (8), eholedocholithiasis (7), trauma-related pancreatitis (6), suspected biliary leak (3), abdominal pain (3), gallstone pancreatitis (1), biliary obstruction without stones (1), and abnormal LFTs without pain (1). The common bile duct (CBD) and pancreatic duct (PD) were successfully cannulated in 31/31 (100%) attempts. Minor papilla cannulation was successful in 6/6 (100%) patients. One patient had an incomplete ERCP due to agitation under conscious sedation. Findings included pancreatitis without stones (5), PD cut off (5), biliary stones (4), biliary strictures (4), CBD abnormalities without stones/strictures (4), pancreas divisum (3), pancreatitis with stones (2), biliary leak (2), PD rupture (1), normal anatomical variant (1), and normal ERCP (5). There were 15 therapeutic interventions: sphincterotomy with stone extraction (2 CBD, 2 PD), stone extraction without sphincterotomy (3 CBD, 1 PD), stent insertion (3 biliary, 1 PD), biliary stricture dilatation (2), and nasobiliary drain placement (1). There were 4 immediate (but mild) complications: fever (2), rash (l), and mild pancreatitis (1). Conclusion: Diagnostic and therapeutic ERCP in children is well tolerated, safe and likely to be technically successful in experienced hands.