title: Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly being used in the evaluation and management of biliary and pancreatic disorders in children. The aim of this study was to review the pediatric ERCP experience of a large academic referral center affiliated with a tertiary care children's hospital.
  
  
  METHODS
  This is a retrospective review of medical records, endoscopic and operative reports, and radiography of those patients ages 0 to 21 years who underwent ERCP for any indication between 1993 and 2011 at a tertiary referral center affiliated with a large urban pediatric hospital. ERCP technical success was defined as cannulation of the desired duct. Serious adverse events included bleeding, perforation, pancreatitis, or death.
  
  
  RESULTS
  Four hundred twenty-nine ERCPs were performed on 296 patients. The mean age was 14.9 ± 4.8 years (3 months-21 years); 51.1% were boys. Patients with a history of previous liver transplant comprised 13.1% (56) of all ERCPs. Abnormal liver chemistries or suspected choledocholithiasis accounted for half of the indications. A therapeutic intervention was performed in 64.1%. Technical success was achieved in 95.2% of ERCPs. Serious adverse events occurred in 7.7%.
  
  
  CONCLUSIONS
  Pediatric ERCP is highly efficacious in the pediatric population, with the rates of technical success and use of therapeutic interventions mirroring those in adults. There is a low overall rate of serious adverse events. The overall efficacy and safety support the performance of pediatric ERCP by experienced endoscopists at high-volume centers.
authors.affiliation: *Department of Medicine, Division of Gastroenterology, Temple University School of Medicine †Department of Medicine, University of Pennsylvania Perelman School of Medicine ‡Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia §Department of Medicine, The Children's Hospital of Philadelphia, Philadelphia PA ||Department of Medicine, Division of Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Brintha K
authors.initials: BK
authors.lastname: Enestvedt
authors.forename: Christina
authors.initials: C
authors.lastname: Tofani
authors.forename: Dale Y
authors.initials: DY
authors.lastname: Lee
authors.forename: Maíre
authors.initials: M
authors.lastname: Abraham
authors.forename: Pari
authors.initials: P
authors.lastname: Shah
authors.forename: Vinay
authors.initials: V
authors.lastname: Chandrasekhara
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
authors.forename: William
authors.initials: W
authors.lastname: Long
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Ahmad
authors.forename: David L
authors.initials: DL
authors.lastname: Jaffe
authors.forename: Petar
authors.initials: P
authors.lastname: Mamula
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D010179:Pancreas / Q000276:immunology / Q000293:injuries*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012421:Rupture / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control