title: Success and safety of endoscopic retrograde cholangiopancreatography in children.
abstract: OBJECTIVE
  Despite its diagnostic and therapeutic utility, endoscopic retrograde cholangiopancreatography (ERCP) is underutilized in children.
  
  
  METHODS
  Patients younger than 18years undergoing ERCP from 2000 to 2014 at a children's hospital were identified. Patient characteristics and outcomes were evaluated.
  
  
  RESULTS
  Overall, 215 ERCPs (78% therapeutic) were performed in 184 patients. Our cohort was 67% female, with a median age (IQR) of 14 (8) years. Common indications were choledocholithiasis, pancreatitis, sclerosing cholangitis, and postoperative complication. ERCP was performed with an adult duodenoscope in 96% of cases and with a pediatric duodenoscope in the remainder. Patients requiring a pediatric scope ranged in weight from 4.3 to 22.8kg, with ages from 2months to 6years. Cannulation was successful in 97% of cases. Findings included bile duct (BD) stones, BD dilatation, sclerosing cholangitis, BD stricture, pancreatic duct (PD) disruption, choledochal cyst, pancreas divisum, and BD leak. The most common therapeutic techniques were sphincterotomy, stone extraction, and stent. Complication rate was overall 10% with no deaths. On multivariate analysis, PD cannulation was associated with pancreatitis (OR 3.48), while age<4years (10.7), male gender (12.8), and precut sphincterotomy (31.3) were associated with hemorrhage (all p<0.05).
  
  
  CONCLUSIONS
  ERCP can be performed successfully and safely in children with complication rates comparable to those in adults. The type of cannulation and patient age are independent risk factors for complications.
  
  
  METHODS
  Treatment study-IV.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Rosen
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lane
authors.affiliation: Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martinez
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagenaar
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Van Haren
authors.affiliation: Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: JSola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000601:surgery; D015529:Choledochal Cyst / Q000601:surgery; D042883:Choledocholithiasis / Q000601:surgery; D015331:Cohort Studies; D003137:Common Bile Duct Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010182:Pancreatic Diseases / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery; D010195:Pancreatitis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012307:Risk Factors
keywords: Cholangiopancreatography; Endoscopic; Endoscopic retrograde; Gallstones; Outcomes research; Sphincterotomy