Efficacy and safety of endoscopic retrograde cholangiopancreatography in children

Abstract

Objective: To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of biliary and pancreatic diseases in children. Methods: The clinical data of 127 children who were treated with ERCP in the First Affiliated Hospital of Nanchang University from January 2007 to July 2021 were analyzed. According to the diseases they suffered from, the children were divided into biliary group and pancreatic group. The operation times, technical success rate, diagnosis, interventions and post-ERCP complications between the groups were compared by t-test or χ2 test. The risk factors of post-ERCP pancreatitis (PEP) were analyzed by multivariate Logistic regression. Results: A total of 127 children, including 54 males and 73 females, with a median age of 14 years at first ERCP, were included in this study. ERCP was performed in 181 cases, with a success rate of 98.3% (178/181). In pre-ERCP imaging examination, the positive diagnostic rates of ultrasound, CT and magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic diseases were 54.1% (53/98), 56.1% (37/66) and 79.3% (88/111), respectively. MRCP had the highest positive diagnostic rate, and the difference among the three measures was statistically significant (χ2=17.33, P<0.001). The most common indications for ERCP in biliary and pancreatic diseases were choledocholithiasis (77.0%, 107/139) and congenital structural abnormalities of the pancreas (31.0%, 13/42), respectively. After ERCP, the abdominal pain was dramatically relieved and the liver function was significantly improved (all P<0.001). The blood amylase level of the children with pancreatic diseases was significantly lower than that before ERCP (t=7.73, P<0.001). The overall incidence of post-ERCP complications was 12.2% (22/181), of which post-ERCP pancreatitis (PEP) was the most common (7.2%, 13/181). The incidence of PEP was significantly higher in the pancreatic group than in the biliary group (16.7% (7/42) vs. 4.3% (6/139),χ2=7.38, P=0.007). Multivariate Logistic regression analysis showed that young age was the independent risk factor of PEP (OR=0.80, 95%CI 0.67-0.96). Conclusions: MRCP is the first choice for pre-ERCP imaging examination of biliary and pancreatic diseases in children. ERCP can be safely and effectively used in the diagnosis and treatment of biliary and pancreatic diseases in children, with a high success rate and obvious alleviation of symptoms.