INDICATIONS FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CHILDREN AND ADOLESCENTS

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly utilized in the management of pancreatic and biliary diseases in pediatric practice. Few studies exist evaluating the utility of ERCP in this setting. Methods: We performed a retrospective chart review utilizing an electronic medical record system to review all ERCPs performed in children at our center over an 18 month period. Results: We reviewed 23 ERCPs performed in 18 children ages 5 to 18 years by 3 experienced adult gastroenterologists. Of these procedures the indications were as follows: 9 for choledocholithiasis, 5 for chronic pancreatitis, 5 for stent removal or follow-up of previous ERCP findings, 2 for severe acute pancreatitis following abdominal trauma and 2 for primary sclerosing cholangitis. The majority of procedures (82%) were both diagnostic and therapeutic. Of the 9 initial procedures performed for indications other than choledocholithiasis, 100% led to a new diagnosis improving management and 5 (55%) were therapeutic. Almost all (89%) cases for choledocholithiasis were therapeutic. In 3 cases (13%), post ERCP pancreatitis developed and this resulted in an average of 3.7 days inpatient care post ERCP, but resolved without serious consequences in all 3 cases. There were no failed procedures due to technical difficulties with cannulation. Conclusions: The primary indication for ERCP performed in children in our center was biliary disease, most often choledocholithiasis. The majority of procedures were both diagnostic as well as therapeutic and most procedures significantly impacted the management of the child. Post ERCP pancreatitis was rare and resolved without long-term consequences. Therefore, ERCP is safe and useful in the diagnosis and treatment of pediatric biliary and pancreatic diseases.