Therapeutic endoscopic retrograde cholangiopancreatography in children

Between 1992-1995, 162 ERCP's in 106 children were performed. The most common indications are listed in Table 1. Cannulation rates are shown in Table 2. Definitive diagnoses were provided after ERCP in 61% of the cases while therapeutic interventions were performed in 46% of the procedures. A total of 10 complications with 6 post-procedure pancreatitis, 2 bile duct perforations, and 1 ileus occurred. In seven of these complications, therapeutic interventions were undertaken.(Table 3) Table 1 Hepatobiliary indications No. Pancreatic indications No. Abnormal LFT's 24 Acute/Chronic Pancreatitis 43 CBD Stone 11 Pancreatic fistula 2 Jaundice 8 Pancreatic insufficiency 1 PSC 4 Pseudocyst drainage 1 Miscellaneous 12 Table 2 Years of Age Age (4mos-18yrs) 0 to 6 7 to 12 13 to 18 Total No. of Patients 37 29 40 106 No. of ERCP's 56 44 62 162 Cannulation % 96.6 94 100 - Therapeutic % 35 54 50 - Complications 1 5 2 8(5%) Diagnosis rendered % 51 62 70 - Tables 3 Complications (No.) Therapeutic ERCP Days Hospitalized CBD perforation (2) 2/2 24 Pancreatitis (7) 6/7 4 (Median) Ileus (1) 1/1 7 In experienced centers, the success of cannulating the desired duct in pediatric patients is similar to that of adults. Our series also show that even though complications are rare, they are more likely to occur with therapeutic interventions. Age does not appear to be a factor in determining the success of Cannulation or complications.