Martin Goetz1,2, Philipp Andersen1, Jacques Bergman3, Nicola Frei3, Arthur Schmidt4, Georg Kähler5, Peter Martus6, Alexander Dechêne7,8. 1. Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany. 2. Medizinische Klinik IV, Kliniken Böblingen, Böblingen, Germany. 3. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Medicine II, Faculty of Medicine, University of Freiburg; Medical Centre, Freiburg, Germany. 5. Central Interdisciplinary Endoscopy, Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. 6. Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Universität Tübingen, Tübingen, Germany. 7. Klinik für Innere Medizin 6, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Germany. 8. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Germany.
Abstract
BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is rarely performed in newborns, and the risk of post-ERCP pancreatitis (PEP) has not been defined in this age group. We therefore performed a European multicentre analysis of PEP rates and risk factors in children aged ≤1 year. PATIENTS AND METHODS: Based on a sample size estimation, 135 consecutive ERCPs in 126 children aged ≤1 year were evaluated from five European centres, and the first ERCP per child analysed. All ERCPs and clinical reports were reviewed manually for PEP and associated risk factors. All ERCPs were performed by endoscopists with high ERCP expertise. RESULTS: No PEP was observed (0/126, 0.0%, CI 0-2.9%) despite the formal presence of multiple risk factors and despite lack of PEP prophylaxis (except one patient having received a pancreatic duct stent). The PEP rate was significantly lower than the PEP rate expected in adults with similar risk factors. CONCLUSIONS: ERCP in children aged ≤1 year is safe in terms of PEP. The PEP risk is significantly lower in children aged ≤1 year than in adults, therefore no PEP prophylaxis seems to be needed in young children. Risk factors from adults may not apply to children under 1 year. Reluctance to perform diagnostic ERCP in suspected biliary anomalies should not be based on presumed PEP risk.
BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is rarely performed in newborns, and the risk of post-ERCP pancreatitis (PEP) has not been defined in this age group. We therefore performed a European multicentre analysis of PEP rates and risk factors in children aged ≤1 year. PATIENTS AND METHODS: Based on a sample size estimation, 135 consecutive ERCPs in 126 children aged ≤1 year were evaluated from five European centres, and the first ERCP per child analysed. All ERCPs and clinical reports were reviewed manually for PEP and associated risk factors. All ERCPs were performed by endoscopists with high ERCP expertise. RESULTS: No PEP was observed (0/126, 0.0%, CI 0-2.9%) despite the formal presence of multiple risk factors and despite lack of PEP prophylaxis (except one patient having received a pancreatic duct stent). The PEP rate was significantly lower than the PEP rate expected in adults with similar risk factors. CONCLUSIONS: ERCP in children aged ≤1 year is safe in terms of PEP. The PEP risk is significantly lower in children aged ≤1 year than in adults, therefore no PEP prophylaxis seems to be needed in young children. Risk factors from adults may not apply to children under 1 year. Reluctance to perform diagnostic ERCP in suspected biliary anomalies should not be based on presumed PEP risk.
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: Andrea Tringali; Mike Thomson; Jean-Marc Dumonceau; Marta Tavares; Merit M Tabbers; Raoul Furlano; Manon Spaander; Cesare Hassan; Christos Tzvinikos; Hanneke Ijsselstijn; Jérôme Viala; Luigi Dall'Oglio; Marc Benninga; Rok Orel; Yvan Vandenplas; Radan Keil; Claudio Romano; Eva Brownstone; Štěpán Hlava; Patrick Gerner; Werner Dolak; Rosario Landi; Wolf Dietrich Huber; Simon Everett; Andreas Vecsei; Lars Aabakken; Jorge Amil-Dias; Alessandro Zambelli Journal: Endoscopy Date: 2016-09-12 Impact factor: 10.093
Authors: Peter A Banks; Thomas L Bollen; Christos Dervenis; Hein G Gooszen; Colin D Johnson; Michael G Sarr; Gregory G Tsiotos; Santhi Swaroop Vege Journal: Gut Date: 2012-10-25 Impact factor: 23.059
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: Jasmin Felux; Ekkehard Sturm; Andreas Busch; Emanuel Zerabruck; Florian Graepler; Dietmar Stüker; Andreas Manger; Hans-Joachim Kirschner; Gunnar Blumenstock; Nisar P Malek; Martin Goetz Journal: United European Gastroenterol J Date: 2017-01-11 Impact factor: 4.623