Date Published: January 17, 2019
Publisher: Public Library of Science
Author(s): Radan Keil, Jiří Drábek, Jindra Lochmannová, Jan Šťovíček, Petra Koptová, Martin Wasserbauer, Barbora Frýbová, Jiří Šnajdauf, Jan Matouš, Radana Kotalová, Michal Rygl, Štěpán Hlava, Pavel Strnad.
Endoscopic retrograde cholangiopancreatography (ERCP) is seldom used in children, and published series have limited numbers of pediatric patients. The aim of this retrospective observational study was to assess the efficacy and safety of pediatric ERCP in a large group of children.
Data were evaluated from 626 children with biliopancreatic disorders admitted to University Hospital Motol, Prague, between January 1999 and January 2018. Clinical data were obtained by retrospective evaluation of our database of pediatric ERCP procedures and from clinical records.
We performed 856 ERCPs on 626 pediatric patients; of these procedures, 59% were therapeutic and 41% were diagnostic. We achieved 96% technical success. Indications for ERCP and pathological findings differed in different age groups. The main role of ERCP was in excluding biliary atresia in those aged less than one year. In children aged 1 to 6 years, the most frequent diagnoses were choledochal cyst followed by choledocholithiasis. In children aged 7 to 12 years and 13 to 19 years, the most frequent diagnoses were choledocholithiasis followed by pancreatic pathology. The overall complication rate found in this study was similar to rates observed in adult populations.
Our study shows the efficacy and safety of diagnostic and therapeutic ERCP in a large series of infants and children with technical success and complication rates comparable to those in adults. Our data show that ERCP had different roles in different age groups of children.
Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic and diagnostic technique used routinely in adults. Over the past four decades, there have been technological advancements in noninvasive cross-sectional imaging modalities including the development of magnetic resonance cholangiopancreatography (MRCP). MRCP replaced ERCP as a diagnostic method, but ERCP continues to be a preferred modality for therapeutic interventions in the pancreaticobiliary system. 
In our endoscopic center, we perform 1600–1800 ERCPs in adult patients every year and provide services for children and infants from the area, which includes 5 million inhabitants. Care for these children is organized with close cooperation between adult gastroenterologists, pediatricians and pediatric surgeons.
During a 20-year period, 856 ERCPs were performed in 626 pediatric patients. There were 294 boys and 332 girls. The median age of the children was 4 years and 11 months (range 12 days to 17 years and 6 months), and 58.8% of ERCP procedures were therapeutic and 41.2% were diagnostic.
Our study demonstrates the different uses of diagnostic and therapeutic ERCP in pediatric patients. The procedures were performed by gastroenterologists who mostly treat adult patients. Primary ERCP was successfully completed in 94.6% patients, it is comparable to rates reported in other studies. [12, 13]
The results of our retrospective study illustrate the efficacy and safety of diagnostic and therapeutic ERCP in a large series of infants and children, with technical success and complication rates that are comparable to those in adults. We also demonstrate the different roles of ERCP in different age groups.