Endoscopic retrograde cholangiopancreatography in children: A surgeon's perspective.
OBJECTIVE
The aim of this study was to review the indications, success rate, and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric age group.


METHODS
From 1990 to 1999, 21 ERCP procedures were attempted in 20 patients. They consisted of 8 boys and 12 girls whose age ranged from 4 to 17 years (mean, 11.3 years). Fourteen were performed under deep sedation (mean age, 12.8 years), and 7 were done under general anesthesia (mean age, 7.6 years). All ERCP procedures were performed by experienced adult endoscopists.


RESULTS
The indication for ERCP was biliary in 15 patients. Eleven had suspected choledocholithiasis by either ultrasound scan, intraoperative cholangiogram or magnetic resonance imaging (MRI). In 6 cases, the ERCP was done for pancreatic pathology. In 11 patients, the ERCP was diagnostic only, and in 10 a therapeutic procedure was done. The overall success rate was 90.5%. Post-ERCP complications consisted of 6 episodes of pancreatitis (28.5%), 4 of which followed a therapeutic procedure, and 1 episode of bleeding. Pancreatitis resolved 2 to 6 days post-ERCP. The patients underwent follow-up between 2 and 56 months after the ERCP (mean, 11 months).


CONCLUSIONS
The authors conclude that even in experienced hands, ERCP in the pediatric population has a much higher complication rate than in adults (33.3%). We recommend that very specific indications be met before subjecting a pediatric patient to an endoscopic retrograde cholangiopancreatography.
Prasil
P
P
Division of General Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Laberge
J M
JM
Barkun
A
A
Flageole
H
H
D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis* / Q000601:surgery*; D013502:General Surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology; D018579:Patient Selection; D010372:Pediatrics; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome