Abstract
BackgroundIn adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series.MethodsAll patients <18 years undergoing an ERCP or EUS between January 1992–December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases.ResultsNinety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1–4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy.ConclusionERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.
Highlights
In adults endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions
Such guidelines do not exist for the paediatric population, but a recent study from the USA has shown that the annual numbers of paediatric ERCPs being performed is rising, of late they are almost always being undertaken for therapeutic indications [4]
The lowest rates of adverse events were seen in ERCP procedures performed for chronic pancreatitis, EUS procedures compared to ERCP procedures, or if the procedure was performed by an adult endoscopist compared to a paediatric endoscopist
Summary
In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. With greater availability of alternative diagnostic investigations such as magnetic resonance imaging or EUS, almost all ERCPs in adults are performed for therapeutic indications as advocated by the American Society for Gastrointestinal Endoscopy [17]. Such guidelines do not exist for the paediatric population, but a recent study from the USA has shown that the annual numbers of paediatric ERCPs being performed is rising, of late they are almost always being undertaken for therapeutic indications [4]
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