title: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report.
abstract: OBJECTIVE
  Our goal is to evaluate the indications, findings, therapies, safety, and technical success of endoscopic retrograde cholangiopancreatography (ERCP) in children.
  
  
  METHODS
  Our database was searched for patients 17 years of age or younger undergoing ERCP between January 1994 and March 2003. Additional information was obtained by chart review. The safety and technical success of ERCP were examined. Complications were classified by the consensus criteria.
  
  
  RESULTS
  A total of 245 patients (95 M, 150 F; mean age 12.3 years) underwent 329 examinations. Indications included biliary pathology (n = 93), pancreatic pathology (n = 111), and chronic abdominal pain of suspected biliary or pancreatic origin (n = 41). The ERCP findings were bile duct stone(s) (n = 29), benign biliary stricture (n = 19), primary sclerosing cholangitis (n = 7), anomalous pancreaticobiliary union (n = 8), choledochal cyst (n = 5), bile duct leak (n = 6), malignant biliary stricture (n = 2), biliary atresia (n = 1), chronic pancreatitis (n = 44), pancreas divisum (n = 26), pancreatic duct stricture with (n = 6) or without (n = 9) leak, pancreatic tumor (n = 1), periampullary adenoma (n = 2), and sphincter of Oddi dysfunction (n = 65). Endoscopic therapies were performed in 71% of the procedures and included sphincterotomy, stone extraction, stricture dilation, endoprosthesis placement, snare papillectomy, and cystoduodenostomy. Thirty-two (9.7%) post-ERCP complications occurred and included cholangitis in 1 patient and pancreatitis in 31. The pancreatitis was graded mild in 24, moderate in 5, and severe in 2. No mortality related to ERCP occurred.
  
  
  CONCLUSIONS
  Diagnostic and therapeutic ERCP results are similar in children and adults except for a lower incidence of malignant disease in children. Technical success rates are high. However, ERCP-related pancreatitis is not uncommon, and the risk and benefits should be carefully reviewed before proceeding. Outcome data are necessary and is currently being accumulated at our institution.
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
authors.forename: Chi-Liang
authors.initials: CL
authors.lastname: Cheng
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Croffie
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fitzgerald
authors.forename: Laura
authors.initials: L
authors.lastname: Lazzell-Pannell
authors.forename: Suzette
authors.initials: S
authors.lastname: Schmidt
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000293:Adolescent; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome