title: The safety and efficacy of therapeutic ERCP in the pediatric population performed by adult gastroenterologists.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is much less commonly performed in the pediatric population compared to adults. As a result, few pediatric gastroenterologists receive adequate training in ERCP. At many institutions, pediatric ERCP is performed by adult gastroenterologists not formally trained in pediatric gastroenterology.
  
  
  OBJECTIVE
  The purpose of this study was to assess the efficacy and safety of ERCP performed in pediatric patients by adult gastroenterologists in a single tertiary care center.
  
  
  METHODS
  We performed a retrospective analysis of pooled endoscopic procedures in pediatric patients (age<18 years) at the University of Maryland Medical Center, between 2003 and 2011, by two adult therapeutic endoscopists. Neither endoscopist had formal training in pediatric ERCP prior to 2003. Outcome measures included the procedure indications, cannulation success rates, procedure success rates, type of anesthesia, therapeutic interventions, frequency and type of procedure related complications, and technical complexity.
  
  
  RESULTS
  Forty-five patients were included with a mean age of 12 years (range 6-17). There were a total of 70 ERCP procedures. Choledocholithiasis was the most common indication. Modes of anesthesia included monitored anesthesia care (31, 44.3%), general anesthesia (22, 31.4%) and moderate conscious sedation (17, 24.3%). The papilla cannulation success rate was 98.6% (69/70). Therapeutic maneuvers included 31 biliary sphincterotomies, ten pancreatic sphincterotomies, 17 pancreatic duct stents, 16 bile duct stents, two cystgastrostomy stents, four biliary stricture dilations, one minor papillotomy site dilation, one mechanical lithotripsy and one ampullectomy. The procedural success rate was 97.1% (68/70). The overall complication rate was 7.1% (5/70) with a post-ERCP pancreatitis rate of 4.3% (3/70). Complications included infection (moderate-1), bleeding (moderate-1), and post-ERCP pancreatitis (mild-1, moderate-2).
  
  
  CONCLUSIONS
  ERCP procedures in pediatric patients can be safely and efficaciously performed by adult gastroenterologists trained in advanced endoscopy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA, lhawk002@umaryland.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Halvorson
authors.forename: Kevin
authors.initials: K
authors.lastname: Halsey
authors.forename: Peter
authors.initials: P
authors.lastname: Darwin
authors.forename: Eric
authors.initials: E
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005762:Gastroenterology / Q000592:standards; D006801:Humans; D008297:Male; D012189:Retrospective Studies
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