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Alomari O, Abualkhair KA, Saad K, Magdy S, Omran JA, AlSanafini MM, Hassan LA, ElBasatiny OY, Machane D, Abdulrahim M, Abo-Elmaged HG, Elshaieb M, Elfarargy MS, Elhoufey A, Dailah HG, Sayed AH, Ismail A, Walid B, Hashemy M, Afifi AM, Elgenidy A. Assessing the safety and effectiveness of endoscopic ultrasound for pediatric hepato-pancreatico-biliary disorders: a systematic review. Pediatr Radiol 2025; 55:215-225. [PMID: 39821667 DOI: 10.1007/s00247-024-06159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/20/2024] [Accepted: 12/28/2024] [Indexed: 01/19/2025]
Abstract
BACKGROUND Endoscopic ultrasound (US) has been established as a safe diagnostic tool for adults, but its use in children remains underexplored. The rising prevalence of pediatric hepato-pancreato-biliary disorders requires a closer examination of its utility. In this systematic review, we aimed to evaluate the efficacy, safety, and clinical impact of endoscopic US in the pediatric population, concentrating on its diagnostic accuracy and therapeutic applications. METHODS All related clinical studies were identified by searching the Web of Science databases, PubMed (MEDLINE), Scopus, Cochrane, and Embase. Data were extracted from relevant studies using a pre-planned Excel sheet. RESULTS Twenty-eight studies demonstrated that endoscopic US in children is safe, technically successful, and clinically impactful, offering valuable diagnostic and interventional competencies. Endoscopic US was frequently used for microlithiasis, choledocholithiasis, and pancreaticobiliary anomalies. It reliably outperformed other imaging modalities, effectively reducing the need for more invasive procedures. Endoscopic US had a remarkable clinical impact, with diverse diagnostic yields, highlighting its role in diagnosing and treating children with hepato-pancreato-biliary disorders. The safety profile of endoscopic US in children was excellent, with nominal reported complications. CONCLUSION Our comprehensive review underlines the promising application of endoscopic US in pediatric hepato-pancreato-biliary diseases. The endoscopic US demonstrates its diagnostic accuracy and therapeutic potential in children, offering a non-invasive, safe, and efficient approach. As we move forward, addressing the identified limitations and expanding the pediatric-specific research on endoscopic US will enhance our ability to provide precise and patient-centered care in managing pediatric hepato-pancreato-biliary disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amira Elhoufey
- Assiut University, Assiut, Egypt
- Alddrab University College, Jazan University, Jazan, Saudi Arabia
| | | | | | | | | | | | - Ahmed M Afifi
- University of Texas MD Anderson Cancer Center, Houston, USA
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Çirkin G, Akarsu M, Öztürk Y, İyilikçi L, Güler Y, Gülpinar Aydin Ö. Evaluation of endoscopic retrograde cholangiopancreatography in Turkish children. Medicine (Baltimore) 2024; 103:e41045. [PMID: 39969363 PMCID: PMC11688055 DOI: 10.1097/md.0000000000041045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 12/04/2024] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND This study aimed to evaluate the indications, efficacy, and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients at a single center in Turkey between 2017 and 2021. METHODS A retrospective review was conducted on 50 children (mean age, 12.7 years; range, 1-18 years) who underwent 65 ERCP procedures. Data collected included patient demographics, indications for ERCP, procedural details, success rates, and complications. All procedures were performed using therapeutic duodenoscopes under conscious sedation administered by an anesthesiologist. RESULTS The primary indications for ERCP were biliary tract issues, including choledocholithiasis (52.3%) and chronic pancreatitis (18.5%). The overall cannulation success rate was 92.3%. Multiple therapeutic interventions, such as sphincterotomies and stent placements, were often required. The most common complication was post-ERCP pancreatitis, observed in 6.1% of cases, all of which were moderate. No fatalities or serious anesthesia-related adverse events were reported. CONCLUSION ERCP is an effective and safe therapeutic procedure in pediatric patients when performed in collaboration with adult gastroenterologists, despite technical challenges such as the lack of pediatric-specific duodenoscopes. The findings highlight the need for specialized pediatric ERCP equipment and suggest that centralized ERCP facilities could enhance patient outcomes in Turkey.
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Affiliation(s)
- Gül Çirkin
- Division of Pediatrics, Department of Pediatric Gastroenterology Hepatology and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mesut Akarsu
- Division of Internal Medicine, Department of Gastroenterology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Yesim Öztürk
- Division of Pediatrics, Department of Pediatric Gastroenterology Hepatology and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Leyla İyilikçi
- Division of Anesthesia and Reamination, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Yunus Güler
- Division of Pediatrics, Department of Pediatric Gastroenterology Hepatology and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özlem Gülpinar Aydin
- Division of Pediatrics, Department of Pediatric Gastroenterology Hepatology and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Saraiva RO, Borges VP, Silva MJ, Loureiro R, Capela T, Ramos G, Canena J, Mateus Dias A, Alves R, Coimbra J. Endoscopic Retrograde Cholangiopancreatography on Pediatric Patients: Experience of a Portuguese Adult Gastroenterology Department. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:110-115. [PMID: 38633821 PMCID: PMC11021817 DOI: 10.1159/000529090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 04/19/2024]
Abstract
Introduction Experience with endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population is limited. Few medical centers have experts specifically trained in pediatric therapeutic endoscopy. As a result, patients are generally referred to adult endoscopists with high experience in the procedure. The aim of this study was to characterize the experience of an adult endoscopy unit with ERCP on pediatric patients, with a special focus on very young patients. Methods We retrospectively analyzed indications, technical success rate, final clinical diagnosis, and complications of ERCPs in children <18 years at our tertiary referral hospital center between January 1994 and June 2022. Results Sixty-five ERCPs were performed on 57 children with a median age of 13 years (range 1-17 years). Eleven ERCPs were performed on 9 patients up to 5 years old. Indications for ERCP were as follows: biliary obstruction (n = 40), mainly due to choledocholithiasis, lithiasic acute pancreatitis (n = 19), recurrent pancreatitis (n = 3), stent extraction (n = 2), and post-operative biliary fistula (n = 1). The cannulation success rate was 95.1%. Therapeutic interventions were performed in 79% of ERCP. All patients were followed up as inpatients. Complications were recorded in two procedures (3.1%), and no procedure-related mortality occurred. Conclusion In our experience, ERCP in children can be safely performed with high success rates by advanced adult-trained expert endoscopists at a high-volume center.
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Affiliation(s)
- Rita Ornelas Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Verónica Pavão Borges
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Mário Jorge Silva
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Rafaela Loureiro
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Tiago Capela
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Gonçalo Ramos
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Jorge Canena
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - António Mateus Dias
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Rui Alves
- Department of Pediatric Surgery, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - João Coimbra
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
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Capparelli MA, Cotignola L, Domínguez MV, D'Alessandro PD, Ayarzabal VH, Barrenechea ME. Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis. J Pediatr Surg 2023; 58:2352-2355. [PMID: 37460346 DOI: 10.1016/j.jpedsurg.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Gallstone pancreatitis was historically considered a risk factor for choledocholithiasis (CD). However, recent studies of adult patients evidenced a weak association between gallstone pancreatitis and CD. The aim of this study was to analyze this association in pediatric patients. METHODS We conducted a retrospective study on patients with mild gallstone pancreatitis who underwent any definitive testing for CD (MRCP, ERCP, IOC), managed between March 2010 and September 2022. Patients were classified according to the presence or absence of risk factors for CD (total bilirubin ≥2 mg/dl; common bile duct >6 mm on ultrasound; and/or CD on ultrasound). We evaluated the diagnosis of CD on definitive testing in both groups and analyzed the predictive capacity of the presence of risk factors. RESULTS Eighty-four patients were included in the final analysis. Seventy-nine percent were females. The median age was 13 (4-17) years. Forty-seven (55.9%) patients had one or more risk factors. The definitive testing confirmed 13 (15.5%) cases of CD, 12 (25.5%) in the group of patients with risk factors and 1 (2.7%) in those without risk factors. The sensitivity, specificity, positive predictive value and negative predictive value of the presence of associated risk factors were 92.3, 50.7, 25.5 and 97.3%, respectively. CONCLUSION Pediatric patients with gallstone pancreatitis without associated risk factors have a very low incidence of CD. In these patients we suggest performing a laparoscopic cholecystectomy without intraoperative cholangiography or any other definitive test for CD. LEVEL OF EVIDENCE Level II, retrospective study.
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Affiliation(s)
| | - Luciana Cotignola
- Division of General Surgery, J.P. Garrahan Hospital, Buenos Aires, Argentina
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Rashid R, Arfin MS, Karim ASMB, Alam MB, Mahmud S. Endoscopic Retrograde Cholangiopancreatography in Bangladeshi Children: Experiences and Challenges in a Developing Country. Pediatr Gastroenterol Hepatol Nutr 2022; 25:332-339. [PMID: 35903495 PMCID: PMC9284108 DOI: 10.5223/pghn.2022.25.4.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy. METHODS Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented. RESULTS The median age of the study patients was 10 years (range, 1.7-15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful. CONCLUSION We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.
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Affiliation(s)
- Rafia Rashid
- Department of Pediatric Gastroenterology, Dr. MR Khan Shishu Hospital and Institute of Child Health, Dhaka, Bangladesh
| | - Md Samsul Arfin
- Department of Gastroenterology, Hepatology and Pancreatic Diseases (GHPD), Bangladesh Specialized Hospital, Dhaka, Bangladesh
| | - A S M Bazlul Karim
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Salahuddin Mahmud
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
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Dalal A, Kamat N, Patil G, Daftary R, Maydeo A. Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms. Endosc Int Open 2022; 10:E192-E199. [PMID: 35178337 PMCID: PMC8847054 DOI: 10.1055/a-1675-2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS) is useful in diagnosing and treating childhood pancreatobiliary and gastrointestinal diseases. However, there are limited data on its effectiveness for various indications. Patients and methods This was a retrospective analysis of prospectively collected data of patients who underwent EUS for upper gastrointestinal tract disorders from January 2018 to December 2020 to assess its indications, findings, interventions, and complications. Results Ninety-two procedures were performed in 85 children, (70.5 % male; mean [SD] age 12.1 years [3.9] years) with a mean (SD) symptom duration of 1.1 (0.5) years. The procedures were technically successful in all patients. The primary indication for EUS was abdominal pain in 45(52.9%) and jaundice/cholangitis in 15 patients (17.6 %). General anesthesia was used in 12 (13 %) and TIVA in 80 patients (87 %). The most common diagnostic findings were choledocholithiasis in 21 (24.7 %) and cholelithiasis in 12 patients (14.1 %). Among interventions, EUS-guided cystogastrostomy for pancreatic pseudocyst was done in four patients (4.7 %), and EUS-guided rendezvous for failed ERCP in one patient (1.2 %) with cholangitis. There were no immediate post-procedural complications. Overall, EUS had a meaningful impact on the subsequent clinical management in 69 cases (81.2 %). Conclusions EUS in the pediatric population is safe, effective, and has a meaningful impact in appropriately selected cases. It can act as a rescue in major therapeutic procedures, but adequate care should be taken at the procedural level and during anesthesia.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Rajen Daftary
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Dişçi E, Peksöz R, Yıldız M, Yıldırgan Mİ, Albayrak Y, Fakirullahoğlu M, Fırıncı B, Atamanalp SS. Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2022; 32:320-324. [PMID: 35041496 DOI: 10.1089/lap.2021.0517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique used in the diagnosis and treatment of pancreaticobiliary system. ERCP is used less frequently in children than in adults due to the rarity of pancreaticobiliary diseases and technical difficulties. However, ERCP is a safe, effective diagnosis and treatment tool for children. Methods: All patients within the age range of 1-19 years, who underwent ERCP between 2010 and 2021 at our endoscopy unit, were retrospectively examined. Patient demographics, use of imaging methods, indications, type of sedation, interventions, success of ERCP, findings, and complications were evaluated. Results: Overall, 105 ERCPs were performed in 66 children (29 male and 37 female). The indications were choledocholithiasis, cyst hydatic, choledochal cyst, biliary atresia or anomaly, liver transplantation-related disorders, and pancreatic disorders, respectively. ERCP was finished as diagnostic ERCP in 20% and as therapeutic in 80%. Therapeutic procedures were sphincterotomy, stent placement or removal, stone or debris extraction, and balloon sweep or dilatation, respectively. The success rate in the procedures was 75.23%. The overall complication rate was 15.23%. Postprocedure pancreatitis occurred in 11.42%, hemorrhage occurred in 2.85%, and aggravation of cholangitis in 0.95%. All complications were managed conservatively. Conclusion: ERCP in pediatric patients is a safe procedure that can be performed by adult endoscopists with high success rates. Since our region is an endemic region for hydatid cyst disease, the most common ERCP indication after choledocholithiasis is procedures related to liver hydatid cyst disease. The most common complication was pancreatitis, and complications were treated medically.
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Affiliation(s)
- Esra Dişçi
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | - Rıfat Peksöz
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | - Metin Yıldız
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | | | - Yavuz Albayrak
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | | | - Binali Fırıncı
- Department of Pediatric Surgery, Atatürk University Research Hospital, Erzurum, Turkey
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Abstract
PURPOSE The prevalence of gallstones in children has increased over the last years. Choledocholithiasis (CD) is present in up to 30% of the cases. There is a scarcity of studies on the management of choledocholithiasis in children. The aim of this study was to develop a score that would allow predicting accurately the risk of CD in children with gallstones and reduce the number of non-therapeutic ERCP. MATERIALS AND METHODS We conducted a retrospective study in children with gallstones and suspected CD seen between January 2010 and December 2019. The main outcome was the presence of CD confirmed by at least one of the following diagnostic tests: magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and/or intraoperative cholangiography (IOC). We developed a risk score based on the presence or absence of the following risk factors: acute biliary pancreatitis, ascending cholangitis, elevated liver function tests (AST, ALT, total bilirubin [TB, ≥ 2 mg/dl], conjugated bilirubin, gamma-glutamyl transpeptidase, and alkaline phosphatase), CD on ultrasound (US; this was considered predictive but not confirmatory of CD), and dilation of the common bile duct (> 6 mm) by US. The score was divided into three different categories: low risk (no risk factors), intermediate risk (one risk factor present), high risk (≥ 2 risk factors present or ascending cholangitis). Given the main goal of reducing the number of diagnostic ERCPs, a very-high-risk subgroup (3 risk factors present or ascending cholangitis) was identified. RESULTS We reviewed 133 patients with gallstones and suspected CD. In 56 (42.1%) patients, the presence of CD was confirmed by one or more of the definitive diagnostic tests (MRCP, ERCP, and IOC). The following variables were found to be the strongest predictors of CD: ascending cholangitis, TB ≥ 2 mg/dl, common bile duct > 6 mm, and the presence of CD by US. The positive predictive value for CD was 7.5% in the low-risk group (OR 0.06, P = < 0.001); 22.9% in the intermediate-risk group (OR 0.31, P = 0.007); 77.6% in the high-risk group (OR 20.14, P = < 0.001); and 95.7% in very-high-risk subgroup (OR 49.18, P = < 0.001). CONCLUSION The risk score proposed in this study predicts accurately the presence of CD in children with gallstones. It can serve as a helpful tool to triage the need for costly and complex studies in the workup of CD, particularly in centers with limited resources. Finally, due to its high specificity and positive predictive value (PPV), the use of the very-high-risk criteria would allow for an important decrease in the number of non-therapeutic ERCP.
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Barakat MT, Cholankeril G, Gugig R, Berquist WE. Nationwide Evolution of Pediatric Endoscopic Retrograde Cholangiopancreatography Indications, Utilization, and Readmissions over Time. J Pediatr 2021; 232:159-165.e1. [PMID: 33197494 DOI: 10.1016/j.jpeds.2020.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyze outcome and utilization trends over time of pediatric endoscopic retrograde cholangiopancreatography (ERCP) in an all-capture US population-level study. STUDY DESIGN Using the National Inpatient Sample (2005-2014) and National Readmission Database (2010-2014), we identified pediatric (age <20 years) hospitalizations during which ERCP was performed and assessed ERCP-associated readmissions. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify hospitalization diagnoses, comorbidities, and patient/hospital characteristics. Multivariate logistic regression analyses were performed to determine significant predictors (P < .05) of 30-day readmission. RESULTS A total of 11 060 hospitalized pediatric patients underwent ERCP between 2005 and 2014. Most were female (n = 8859; 81%), aged 14-20 years (n = 9342; 84%), and white (n = 4230; 45%). Most (85%) of ERCPs were therapeutic, and leading indications were biliary (n = 5350; 48%) and pancreatitis (n = 3218; 29%). Thirteen pecent of patients were readmitted post-ERCP. Odds for 30-day readmission were highest for patients with a history of liver transplantation, age 0-4 years, male sex, and obesity (P < .001 for each). Patients in both urban teaching and urban hospitals had much lower odds than those in rural hospitals for prolonged length of stay associated with ERCP. CONCLUSIONS These data represent a comprehensive study of nationwide trends in age-specific volumes and outcomes following ERCP in the pediatric population and provide important insights into trends in pediatric pancreaticobiliary disease management, as well as practice setting, patient characteristics, and patient comorbidities associated with pediatric post-ERCP outcomes, including readmission and length of stay.
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Affiliation(s)
- Monique T Barakat
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA
| | - William E Berquist
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA.
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Åvitsland TL, Aabakken L. Endoscopic retrograde cholangiopancreatography in infants and children. Endosc Int Open 2021; 9:E292-E296. [PMID: 33655024 PMCID: PMC7892276 DOI: 10.1055/a-1337-2212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/19/2020] [Indexed: 01/20/2023] Open
Abstract
Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic. Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.
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Affiliation(s)
- Tone Lise Åvitsland
- Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars Aabakken
- Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Demirbaş F, Kaymazlı M, Çaltepe G, Abbasguliyev H, Kalaycı AG, Bektaş A. Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial. Pediatr Gastroenterol Hepatol Nutr 2021; 24:164-172. [PMID: 33833972 PMCID: PMC8007838 DOI: 10.5223/pghn.2021.24.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. METHODS Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. RESULTS Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. CONCLUSION Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.
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Affiliation(s)
- Fatma Demirbaş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Kaymazlı
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Ayhan Gazi Kalaycı
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Bektaş
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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Altonbary AY, Hakim H, Elkashef W. Role of endoscopic ultrasound in pediatric patients: A single tertiary center experience and review of the literature. World J Gastrointest Endosc 2020; 12:355-364. [PMID: 33133372 PMCID: PMC7579528 DOI: 10.4253/wjge.v12.i10.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although endoscopic ultrasound (EUS) is now widely available and has an established role in adults, the utility of EUS and EUS-guided fine needle aspiration (EUS-FNA) in pediatrics is insufficiently described compared to adults and is supported by only a few studies. AIM To report the experience of a single tertiary center in the use of EUS and EUS-FNA in a pediatric population and to further assess its safety, feasibility, and clinical impact on management. METHODS A retrospective study of 13 children (aged 18 years or younger) identified from our medical database was conducted. A retrospective review of demographic data, procedure indications, EUS findings, and the clinical impact of EUS on the subsequent management of these patients was performed. RESULTS During the 4-year study period, a total of 13 (1.7%) pediatric EUS examinations out of 749 EUS procedures were performed in our unit. The mean age of these 8 females and 5 males was 15.6 years (range: 6-18). Six of the 13 EUS examinations were pancreatobiliary (46.1%), followed by mediastinal 2/13 (15.4%), peri-gastric 2/13 (15.4%), abdominal lymphadenopathy 1/13 (7.7%), tracheal 1/13 (7.7%) and rectal 1/13 (7.7%). Overall, EUS-FNA was performed in 7 patients (53.8%) with a diagnostic yield of 100%. The EUS results had a significant impact on clinical care in 10/13 (77%) cases. No complications occurred in these patients during or after any of the procedures. CONCLUSION EUS and EUS-FNA in the pediatric population are safe, feasible, and have a significant clinical impact on the subsequent management; thus avoiding invasive and unnecessary procedures.
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Affiliation(s)
- Ahmed Youssef Altonbary
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Hazem Hakim
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Wagdi Elkashef
- Department of Pathology, Mansoura University, Mansoura 35111, Egypt
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13
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Abstract
BACKGROUND AND AIMS Endoscopic procedures are important for diagnosis and management of many gastrointestinal, liver, and biliary conditions in children. Therapeutic endoscopy procedures, including endoscopic retrograde cholangiopancreatography (ERCP), are performed less frequently in children relative to adults. A formal study to evaluate institutional volumes and practice patterns for advanced therapeutic pediatric endoscopy procedures has, however, not been previously undertaken. METHODS A self-administered 16-question (5-minute) online survey assessing practice patterns for performance of pediatric endoscopy procedures was distributed to all registered North American Society for Pediatric Gastroenterology, Hepatology and Nutrition programs. Results were analyzed using descriptive statistics and thematic analysis of free-text comments. RESULTS Respondents from 82.9% of North American Society for Pediatric Gastroenterology, Hepatology and Nutrition centers completed this survey. Responses revealed that esophagogastroduodenoscopy/colonoscopy are performed at the vast majority of centers (>90%), with most performing >50/year. Therapeutic endoscopy procedures are performed less frequently in the pediatric population, with 18.97% reporting that ERCP is not performed at their institution. Where ERCP is performed, 91.38% reported <25/year. Endoscopic ultrasound is not performed at more than half (53.33%) of institutions. Approximately 71.67% of respondents do not believe their institution's current arrangement for performing pediatric therapeutic endoscopy procedures is adequate. CONCLUSIONS Although the range of endoscopic procedures performed in children parallels that performed in adults, there are notable differences in pediatric and adult gastroenterologists' endoscopy training and procedure volumes. Our results and respondent comments suggest that pediatric patients would benefit from a partnership between pediatric and adult gastroenterologists, with adult gastroenterologists performing more complex therapeutic endoscopic procedures.
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14
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Maruyama H, Shibata Y, Xia XG, Sun YX, He SR, Ito Y. Comparison of decision-making in neonatal care between China and Japan. World J Pediatr 2019; 15:85-91. [PMID: 30470979 DOI: 10.1007/s12519-018-0211-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various differences between China and Japan in approaches to medical treatment have been noted, but a few studies have examined differences in medical decision-making, especially in neonatal care. The aim of this study was to clarify these differences by means of a questionnaire. METHODS The subjects were physicians on the staff of NICUs in China and Japan. The study questionnaire consisted of three parts dealing with the general characteristics of the participants, questions about treatment strategies for hypothetical, critically ill infants, and general questions about the treatment of foreign patients. The Likert scale was used to assess the treatment strategies and the results were analyzed statistically. Subgroup analysis by age, sex, and medical and NICU experience was also performed. RESULTS The proportion of respondents in the Chinese and Japanese groups was 26/26 (100%) and 26/31 (84%), respectively. There was a significant difference between the Chinese and Japanese groups for 8 of 75 questions; Chinese physicians chose the positive treatment or examination options for these eight questions unlike their Japanese counterparts. The responses of the younger, less experienced physicians in both countries were more similar to each other, and more positive than those of their older, more experienced colleagues. CONCLUSION Chinese physicians showed a more positive attitude toward examination and treatment, whereas Japanese physicians showed a more cautious attitude.
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Affiliation(s)
- Hidehiko Maruyama
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Yuka Shibata
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Xing-Ge Xia
- Division of NICU, Guangdong General Hospital Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yun-Xia Sun
- Division of NICU, Guangdong General Hospital Guangdong Academy of Medical Sciences, Guangdong, China
| | - Shao-Ru He
- Division of NICU, Guangdong General Hospital Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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15
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Asenov Y, Akın M, Cantez S, Gün Soysal F, Tekant Y. Endoscopic retrograde cholangiopancreatography in children: Retrospective series with a long-term follow-up and literature review. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:192-197. [PMID: 30459128 DOI: 10.5152/tjg.2018.18165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS To investigate the safety and long-term results of endoscopic retrograde cholangiopancreatography (ERCP) in children with a literature review. MATERIALS AND METHODS All patients within the age range of 6-17 years who underwent ERCP between 1994 and 2014 at our institution were retrospectively evaluated. RESULT Twenty-four patients with a median age of 15 years underwent ERCP. Cannulation of the papilla was achieved in all patients (100%) without the use of needle-knife papillotomy. Before 1999, ERCP was used as a diagnostic method only in 7 patients (29%). In 17 (71%) patients, the procedure was used for therapeutic purposes. The indications were choledocholithiasis (10 cases, 42%), postoperative complications (5 patients, 21%), and recurrent pancreatitis (2 cases, 8%). In 2 patients (8%), the therapeutic effect was not achieved, thus requiring subsequent operations. There were no major complications. Mild pancreatitis occurred in only 1 patient (4%). Long-term follow-up information was obtained in 16 (67%) patients (median, 18 years; range, 3.5-22.5 years), and no long-term complications were detected. CONCLUSION Endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis and treatment of pancreatobiliary disorders in the pediatric population. Large-scale studies are required to create evidence-based guidelines specific to children.
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Affiliation(s)
- Yavor Asenov
- Clinical Center of Gastroenterology, Medical University of Sofia, University Hospital "Tsaritsa Yoanna - ISUL", Sofia, Bulgaria
| | - Melih Akın
- Department of Pediatric Surgery, Health Sciences University Şişli Hamidiye Etfal Hospital, İstanbul, Turke
| | - Serdar Cantez
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, İstanbul University School of Medicine, İstanbul, Turkey
| | - Feryal Gün Soysal
- Department of Pediatric Surgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Yaman Tekant
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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16
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Keane MG, Kumar M, Cieplik N, Thorburn D, Johnson GJ, Webster GJ, Chapman MH, Lindley KJ, Pereira SP. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr 2018; 18:42. [PMID: 29426291 PMCID: PMC5807847 DOI: 10.1186/s12887-017-0959-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series. Methods All patients <18 years undergoing an ERCP or EUS between January 1992–December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases. Results Ninety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1–4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy. Conclusion ERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.
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Affiliation(s)
- Margaret G Keane
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Mayur Kumar
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Natascha Cieplik
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - George J Webster
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Michael H Chapman
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Keith J Lindley
- Department of Gastroenterology, Great Ormond Street Hospital, London, WC1N 3JN, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK.
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17
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Fugazza A, Bizzarri B, Gaiani F, Manfredi M, Ghiselli A, Crafa P, Carra MC, de’Angelis N, de’Angelis GL. The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature. BMC Pediatr 2017; 17:203. [PMID: 29212476 PMCID: PMC5719791 DOI: 10.1186/s12887-017-0956-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of endoscopic ultrasound (EUS) in the management of pancreatobiliary and digestive diseases is well established in adults, but it remains limited in children. The aim of this study was to evaluate the feasibility, safety, and clinical impact of EUS use in children. METHODS This is a retrospective analysis of a prospectively acquired database of consecutive pediatric (< 18 years) patients presenting an indication for EUS for pancreatobiliary and gastrointestinal disorders. RESULTS Between January 2010 and January 2016, 47 procedures were performed in 40 children (mean age of 15.1 ± 4.7 years; range 3-18). The majority of EUS (n = 32; 68.1%) were performed for pancreatobiliary and upper gastrointestinal pathologies, including suspected common bile duct stones (CBDs), acute biliary pancreatitis, recurrent/chronic pancreatitis, cystic pancreatic mass, recurrent hypoglycemia, duodenal polyp, gastric submucosal lesion, and perigastric abscess. In only 2 out of 18 children with suspected CBDs or acute biliary pancreatitis, EUS confirmed CBDs. EUS-guided fine needle aspiration was performed in 3 (6.4%) patients. Fifteen (31.9%) procedures were performed for lower gastrointestinal tract disorders, including suspected anal Crohn's disease, fecal incontinence, and encopresis. Overall, EUS had a significant impact on the subsequent clinical management in 87.2% of patients. CONCLUSION The present findings were consistent with results observed in the current relevant literature and support EUS as a safe and feasible diagnostic and therapeutic tool, which yields a significant clinical impact in children with pancreatobiliary and gastrointestinal disorders.
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Affiliation(s)
- Alessandro Fugazza
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Marco Manfredi
- Department of Pediatrics, “Pietro Barilla” Children’s Hospital, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Alessia Ghiselli
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Pellegrino Crafa
- Department of Pathology, University Hospital of Parma, 43126 Parma, Italy
| | | | - Nicola de’Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, 94010 Paris, Créteil France
- Cancer Research Lab. EC2M3, Université Paris-Est, Créteil, Val de Marne UPEC, 94010 Paris, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
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18
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Rosen JD, Lane RS, Martinez JM, Perez EA, Tashiro J, Wagenaar AE, Van Haren RM, Kumar A, Sola JE. Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 2017; 52:1148-1151. [PMID: 28188033 DOI: 10.1016/j.jpedsurg.2017.01.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE 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). CONCLUSION 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. LEVEL OF EVIDENCE Treatment study-IV.
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Affiliation(s)
- Jordan D Rosen
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rebecca S Lane
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jose M Martinez
- Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Robert M Van Haren
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ashwini Kumar
- Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall'Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber WD, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64:133-153. [PMID: 27622898 DOI: 10.1097/mpg.0000000000001408] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
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Affiliation(s)
- Mike Thomson
- *International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, Weston Bank, Sheffield, UK †Digestive Endoscopy Unit, Catholic University, Rome, Italy ‡Gedyt Endoscopy Center, Buenos Aires, Argentina §Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal ||Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands ¶Department of Pediatric Gastroenterology and Nutrition, University Children's Hospital Basel, Basel, Switzerland #Department of Gastroenterology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands **Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy ††Department of Pediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK ‡‡Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands §§Department of Pediatric Gastroenterology, Robert-Debré Hospital, Paris, France ||||Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy ¶¶Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia ##Pediatric Gastroenterology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ***Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic †††Department of Pediatrics, University of Messina, Messina, Italy ‡‡‡IV Medical Department, Rudolfstiftung Hospital, Vienna, Austria §§§Department of General Pediatrics, Children's Hospital Freiburg University, Freiburg, Germany ||||||Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria ¶¶¶Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK ###Department for Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Austria ****GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway ††††Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Robbiani di Soresina, Soresina, Italy
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Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:825-839. [PMID: 27931639 DOI: 10.1016/j.bpg.2016.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
The experience of the "endoscopic community" in pediatric patients is limited, but during recent years increased skills of the endoscopists and technological improvements lead to a standardization of pediatric endoscopy and the development of specialized pediatric endoscopy unit. Adverse events related to diagnostic and therapeutic endoscopy in children are usually rare. Diagnosis, prevention and treatment of complications in pediatric endoscopy is crucial when dealing with benign diseases in children. The complication rate of diagnostic EGD and colonoscopy in children are extremely low. Therapeutic procedures have obviously an increased rate of adverse events. Esophageal dilations are the most common indication for endoscopic therapy in children and can lead to perforations which requires prompt diagnosis and management. Complications of ERCP in pediatric age are similar to those reported in adults. The experience in pediatric emergency endoscopy (mainly foreign body removal) is consolidated and related adverse events extremely rare. Sedation of children during endoscopy maybe needs further evaluation and standardization, to reduce the rate of specific complications.
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Affiliation(s)
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.
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21
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Mahajan R, Simon EG, Chacko A, Reddy DV, Kalyan PR, Joseph AJ, Dutta AK, Chowdhury SD, Kurien RT. Endoscopic ultrasonography in pediatric patients--Experience from a tertiary care center in India. Indian J Gastroenterol 2016; 35:14-9. [PMID: 26946134 DOI: 10.1007/s12664-016-0619-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Although endoscopic ultrasound (EUS) is used in the management of various gastrointestinal (GI) diseases in adults, data on its role in children is limited. This study evaluated the indications, safety, and impact of EUS in children. METHODS Records of children (<18 years age) who underwent EUS between January 2006 and September 2014 were reviewed retrospectively and analyzed. RESULTS One hundred and twenty-one children (70 males, 51 females) aged 15.2 ± 2.9 years (mean ± SD) underwent 123 diagnostic (including fine needle aspiration cytology (FNAC) in 7) and 2 therapeutic EUS procedures. Conscious sedation was used in 81 procedures (65%) and general anesthesia in 44 (35%). The pancreaticobiliary system was evaluated in 114 (118 procedures), mediastinum in 5, and stomach in 2 patients. EUS diagnosed chronic pancreatitis (21 patients), pancreatic necrosis (1), splenic artery pseudoaneurysm (1), gastric varix (1), pseudocysts (3), insulinomas (2), other pancreatic masses (2), choledocholithiasis (2), choledochal cysts (2), portal biliopathy (1), esophageal leiomyoma (1), gastric neuroendocrine tumor (NET) (1), and GI stromal tumor in stomach (1). EUS-guided FNAC was positive in four of seven patients (two had tuberculosis, one pancreatic solid pseudopapillary tumor, and one gastric NET). Three patients had minor adverse events. EUS had a positive clinical impact in 43 (35.5%) patients. CONCLUSIONS EUS is feasible and safe in children. It provides valuable information that helps in their clinical management.
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Affiliation(s)
- Ramit Mahajan
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India.
| | - Ashok Chacko
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - D Viswanath Reddy
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - P Rupesh Kalyan
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Sudipta Dhar Chowdhury
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
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Othman MO, Qureshi WA. ERCP in Children, Pregnant Patients, and the Elderly. ADVANCED PANCREATICOBILIARY ENDOSCOPY 2016:159-168. [DOI: 10.1007/978-3-319-26854-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Temiz A. Efficiency of upper gastrointestinal endoscopy in pediatric surgical practice. World J Clin Pediatr 2015; 4:113-119. [PMID: 26566483 PMCID: PMC4637801 DOI: 10.5409/wjcp.v4.i4.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
After the introduction of flexible fiber optic endoscopy to pediatric gastroenterology in the 1970s, upper gastrointestinal (UGI) endoscopy can be performed for the diagnosis and treatment of all age groups of children. We review indications, contraindications, preparation of patients for the procedure, and details of diagnostic and therapeutic UGI endoscopy used in pediatric surgery. We also discuss potential complications of endoscopy.
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