Australian audit of endoscopic retrograde cholangiopancreatography outcomes in the pediatric population

Abstract

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be safe and effective in small international retrospective pediatric series; however, there are no Australian data comparing safety and efficacy with adult standards. Our aims were to determine the indications for ERCP in the pediatric population and to assess outcomes and complication rates in comparison with the adult population. Methods: A retrospective audit was conducted of all pediatric patients undergoing ERCP at two tertiary centers. All patients < 18 years of age were considered for analysis. Patients with inadequate documentation to determine endpoints were excluded. Outcomes of interest included baseline characteristics, indications, ERCP findings, complications, and outcomes including length of hospital stay. Statistical analysis was performed with Microsoft Excel. Results: There were 144 procedures conducted in 96 patients over 20.5 years (on average, seven per year across two centers). Of these patients, 75 (77.3%) required a single ERCP, with the remainder undergoing between two and six procedures (median, 1). All procedures were performed by two gastroenterologists accredited in adult ERCP procedures and with (Figure presented) (Table presented) experience in performing pediatric ERCPs and other advanced endoscopic procedures. The median age at first ERCP was 11.56 years (range, 1.1- 17.6), with a success rate of native papilla ERCPs of 96.9% (n = 93). Median body mass index was 19.9 kg/m2, and 46.5% of the cohort were male. There were 61 patients (42.4%) who had previous abdominal surgeries before their ERCP. The most common indication was for choledocholithiasis (Fig. 1). Procedural outcomes are shown in Table 1. Overall, 34.7% of patients required stent insertions. The pancreatitis rate was 9.4% in patients undergoing native papilla ERCP, with an overall complication rate of 13.2%. Conclusion: Pediatric ERCP is an uncommon procedure. Successful biliary cannulation in a pediatric population is comparable to that in adult populations, but with a comparably higher post-ERCP pancreatitis rate (9%) and complication rate (13%). These are higher than the reported complication rates in adults, according to American Society for Gastrointestinal Endoscopy guidelines, with pancreatitis rates between 1% and 7%, bleeding < 2%, and infection < 1%.1 A third of patients required stent insertions and, therefore, at least one follow-up ERCP. The pediatric population, although younger and with fewer comorbidities, is likely a more complex group of patients, with significant previous abdominal surgical history and more complicated indications for ERCP compared with adult patients. Higher pancreatitis rates may reflect the nature and complexity of pediatric hepato-pancreato-biliary disease or a relatively greater mass of functioning pancreatic parenchyma, rather than procedural factors. Reference 1 Adler DG, Lieb JG 2nd, Cohen J, et al. Quality indicators for ERCP. Gastrointest Endosc 2015; 81: 54-66.L6294564152019-10-04 <br />