Jasmin Felux1, Ekkehard Sturm2, Andreas Busch2, Emanuel Zerabruck1, Florian Graepler1, Dietmar Stüker3, Andreas Manger4, Hans-Joachim Kirschner5, Gunnar Blumenstock6, Nisar P Malek1, Martin Goetz1. 1. Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany. 2. Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Germany. 3. Allgemeine, Viszeral- und Transplantationsmedizin, Universitätsklinikum Tübingen, Tübingen, Germany. 4. Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Tübingen, Germany. 5. Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Tübingen, Germany. 6. Klinische Epidemiologie und angewandte Biometrie, University of Tübingen, Tübingen, Germany.
Abstract
BACKGROUND: Indications for endoscopic retrograde cholangiopancreatography (ERCP) in children differ from adults. Paucity of data and concerns about potential lower effectiveness and more side effects limit its use even in high volume centers. We retrospectively analyzed indications, success rates, limitations, and side effects of ERCPs in children <18 years. METHODS: From January 2012 to March 2015, 54 ERCPs were performed in 31 children (median age 11 (0-17) years; median weight 22 (3.3-142.7) kg) with suspected choledocholithiasis (n = 13 interventions in 9 patients), post-transplantation anastomotic stenosis (10/4), malignancy (10/5), chronic pancreatitis (7/1), biliary atresia (6/6), anomaly (2/2), leak (4/3), or primary sclerosing cholangitis (PSC) (2/1). All patients were followed up as inpatients. RESULTS: Thirty-six therapeutic and 18 diagnostic procedures were performed by adult ERCP expert endoscopists. Successful intervention was achieved in 90.7% of cases. Failed cannulation (n = 4) was associated with lower body weight (p = 0.023). In children younger than 1 year, ERCP was significantly more often diagnostic than in patients >1 year (p < 0.001). In three of six infants with suspected atresia, surgical exploration was avoided. Five complications were recorded (9.3%), and included four episodes of mild pancreatitis (7.4% post-ERCP pancreatitis (PEP) rate) and one cholangitis in PSC. A trend towards a protective effect of pancreatic stents on PEP was observed. All complications were managed conservatively. No complications were attributed to mechanical stress on the gastrointestinal tract. CONCLUSIONS: ERCP in newborns, infants, and adolescents can be safely performed with high technical and clinical success. Endoscopists must be aware of differing spectrum of pediatric diseases. Failed cannulation was associated with lower body weight of young children. Complications were similar to rates reported in adults.
BACKGROUND: Indications for endoscopic retrograde cholangiopancreatography (ERCP) in children differ from adults. Paucity of data and concerns about potential lower effectiveness and more side effects limit its use even in high volume centers. We retrospectively analyzed indications, success rates, limitations, and side effects of ERCPs in children <18 years. METHODS: From January 2012 to March 2015, 54 ERCPs were performed in 31 children (median age 11 (0-17) years; median weight 22 (3.3-142.7) kg) with suspected choledocholithiasis (n = 13 interventions in 9 patients), post-transplantation anastomotic stenosis (10/4), malignancy (10/5), chronic pancreatitis (7/1), biliary atresia (6/6), anomaly (2/2), leak (4/3), or primary sclerosing cholangitis (PSC) (2/1). All patients were followed up as inpatients. RESULTS: Thirty-six therapeutic and 18 diagnostic procedures were performed by adult ERCP expert endoscopists. Successful intervention was achieved in 90.7% of cases. Failed cannulation (n = 4) was associated with lower body weight (p = 0.023). In children younger than 1 year, ERCP was significantly more often diagnostic than in patients >1 year (p < 0.001). In three of six infants with suspected atresia, surgical exploration was avoided. Five complications were recorded (9.3%), and included four episodes of mild pancreatitis (7.4% post-ERCP pancreatitis (PEP) rate) and one cholangitis in PSC. A trend towards a protective effect of pancreatic stents on PEP was observed. All complications were managed conservatively. No complications were attributed to mechanical stress on the gastrointestinal tract. CONCLUSIONS: ERCP in newborns, infants, and adolescents can be safely performed with high technical and clinical success. Endoscopists must be aware of differing spectrum of pediatric diseases. Failed cannulation was associated with lower body weight of young children. Complications were similar to rates reported in adults.
Authors: Bradley A Barth; Subhas Banerjee; Yasser M Bhat; David J Desilets; Klaus T Gottlieb; John T Maple; Patrick R Pfau; Douglas K Pleskow; Uzma D Siddiqui; Jeffrey L Tokar; Amy Wang; Louis-Michel Wong Kee Song; Sarah A Rodriguez Journal: Gastrointest Endosc Date: 2012-05-12 Impact factor: 9.427
Authors: Jean-Marc Dumonceau; Angelo Andriulli; B Joseph Elmunzer; Alberto Mariani; Tobias Meister; Jacques Deviere; Tomasz Marek; Todd H Baron; Cesare Hassan; Pier A Testoni; Christine Kapral Journal: Endoscopy Date: 2014-08-22 Impact factor: 10.093
Authors: Claus Petersen; Peter N Meier; Andrea Schneider; Carmen Turowski; Eva D Pfister; Michael P Manns; Benno M Ure; Jochen Wedemeyer Journal: J Hepatol Date: 2009-08-06 Impact factor: 25.083
Authors: D Kohoutova; A Tringali; G Papparella; V Perri; I Boškoski; J Hamanaka; G Costamagna Journal: United European Gastroenterol J Date: 2018-12-05 Impact factor: 4.623
Authors: Martin Goetz; Philipp Andersen; Jacques Bergman; Nicola Frei; Arthur Schmidt; Georg Kähler; Peter Martus; Alexander Dechêne Journal: United European Gastroenterol J Date: 2019-09-03 Impact factor: 4.623
Authors: Radan Keil; Jiří Drábek; Jindra Lochmannová; Jan Šťovíček; Petra Koptová; Martin Wasserbauer; Barbora Frýbová; Jiří Šnajdauf; Jan Matouš; Radana Kotalová; Michal Rygl; Štěpán Hlava Journal: PLoS One Date: 2019-01-17 Impact factor: 3.240