ERCP in the evaluation of abdominal pain in children.
BACKGROUND
ERCP is feasible and safe in the pediatric population. Its utility in the evaluation of children with pain suggestive of a pancreatobiliary origin without objective findings compared with those with abnormal biochemical and/or imaging studies is not well known.


OBJECTIVE
To determine the utility of ERCP in the diagnosis and management of children seen with abdominal pain.


METHODS
Retrospective review.


METHODS
One tertiary center.


METHODS
All children who underwent ERCP at one tertiary center from 1994 to 2004.


METHODS
An endoscopy database was used. Data sets with regard to indications, technical success, complications, and outcomes were evaluated. Before ERCP, children with abdominal pain were categorized into 2 groups: group I, those with objective findings, namely abnormal biochemistry and/or abnormal imaging studies; group II, those who had abdominal pain without objective findings.


METHODS
ERCP success and failure rates, findings, interventions, complications, and outcomes were determined. Data were compared between group I and group II.


RESULTS
A total of 185 consecutive children with abdominal pain who underwent ERCP were identified (131 in group I and 54 in group II). ERCP technical success was achieved in 98%. In group I, ERCP identified a cause for abdominal pain in 93 of 129 children (72%). Fifty-four of 93 patients (58%) in this group underwent endoscopic intervention with resolution of pain. In group II, a cause for abdominal pain was identified in 30 of 53 children (56%)(P < .025 compared with group I). Fourteen of 30 patients (47%) in this group underwent endoscopic intervention with resolution of pain. Complications noted were mild pancreatitis in two and self-limited bleeding in one.


CONCLUSIONS
A retrospective study, one tertiary center where the majority of the ERCPs were performed by one experienced operator.


CONCLUSIONS
ERCP in children with abdominal pain suggestive of a pancreatobiliary origin has a favorable risk:benefit ratio.
Dua
Kulwinder
K
Division of Gastroenterology and Hepatology, Froedtert Memorial Hospital, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Miranda
Adrian
A
Santharam
Raj
R
Ramanujam
Srihari
S
Werlin
Steven
S
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D001649:Bile Duct Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies