title: Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience.
abstract: BACKGROUND
  There are few data regarding endoscopic retrograde cholangiopancreatography (ERCP) usefulness in children and adolescents. We reviewed the long-term experience with diagnostic and therapeutic ERCP in a tertiary single center in Southern Brazil.
  
  
  METHODS
  A retrospective chart review of patients aged 0-18 years who had undergone ERCPs from January 2000 to June 2012 was done. Data on demographics, indications, diagnosis, treatments, and complications were collected.
  
  
  RESULTS
  Seventy-five ERCPs were performed in 60 patients. The median age of the patients at the procedure was 13.9 years (range: 1.2-17.9). Of the 60 patients, 47 (78.3%) were girls. Of all ERCPs, 48 (64.0%) were performed in patients above 10 years and 35 (72.9%) of them were in girls. ERCP was indicated for patients with bile duct obstruction (49.3%), sclerosing cholangitis (18.7%), post-surgery complication (12%), biliary stent (10.7%), choledochal cyst (5.3%), and pancreatitis (4%). The complication rate of ERCP was 9.7% involving mild bleeding, pancreatitis and cholangitis. Patients who had therapeutic procedures were older (13.7±3.9 vs. 9.9±4.9 years; P=0.001) and had more extrahepatic biliary abnormalities (82% vs. 50%; P=0.015) than those who had diagnostic ERCPs. A marked change in the indications of ERCPs was found, i.e., from 2001 to 2004, indications were more diagnostic and from 2005 therapeutic procedures were predominant.
  
  
  CONCLUSIONS
  Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic ultrasound. All these procedures are complementary and ERCP still has a role for therapeutic purposes.
authors.affiliation: Post-Graduate Program of Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Kieling
authors.forename: Cristiane
authors.initials: C
authors.lastname: Hallal
authors.forename: Camila O
authors.initials: CO
authors.lastname: Spessato
authors.forename: Luciana M
authors.initials: LM
authors.lastname: Ribeiro
authors.forename: Helenice
authors.initials: H
authors.lastname: Breyer
authors.forename: Helena A S
authors.initials: HA
authors.lastname: Goldani
authors.forename: Ismael
authors.initials: I
authors.lastname: Maguilnik
mesh_terms: D000293:Adolescent; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies