Skip to main content
SpringerLink
Log in

Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

There are few data regarding endoscopic retrograde cholangiopancreatography (ERCP) usefulness in children and adolescents. We reviewed the long-term experience with diagnostic and therapeutic ERCP in a tertiary single center in Southern Brazil.

Methods

A retrospective chart review of patients aged 0–18 years who had undergone ERCPs from January 2000 to June 2012 was done. Data on demographics, indications, diagnosis, treatments, and complications were collected.

Results

Seventy-five ERCPs were performed in 60 patients. The median age of the patients at the procedure was 13.9 years (range: 1.2–17.9). Of the 60 patients, 47 (78.3%) were girls. Of all ERCPs, 48 (64.0%) were performed in patients above 10 years and 35 (72.9%) of them were in girls. ERCP was indicated for patients with bile duct obstruction (49.3%), sclerosing cholangitis (18.7%), post-surgery complication (12%), biliary stent (10.7%), choledochal cyst (5.3%), and pancreatitis (4%). The complication rate of ERCP was 9.7% involving mild bleeding, pancreatitis and cholangitis. Patients who had therapeutic procedures were older (13.7±3.9 vs. 9.9±4.9 years; P=0.001) and had more extrahepatic biliary abnormalities (82% vs. 50%; P=0.015) than those who had diagnostic ERCPs. A marked change in the indications of ERCPs was found, i.e., from 2001 to 2004, indications were more diagnostic and from 2005 therapeutic procedures were predominant.

Conclusions

Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic ultrasound. All these procedures are complementary and ERCP still has a role for therapeutic purposes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Williams CI, Shaffer EA. Gallstone disease: current therapeutic practice. Curr Treat Options Gastroenterol 2008;11:71–77.

    Article  PubMed  Google Scholar 

  2. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al. Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005;62:1–8.

    Article  PubMed  Google Scholar 

  3. Poddar U, Thapa BR, Bhasin DK, Prasad A, Nagi B, Singh K. Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol 2001;6:927–931.

    Article  Google Scholar 

  4. Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group. Pediatr Surg Int 2007;23:111–116.

    Article  PubMed  Google Scholar 

  5. Javid G, Zargar S, Shah A, Shoukat A, Iqball A, Gupta A. Etiology and outcome of acute pancreatitis in children in Kashmir (India). An endemic area of hepatobiliary ascariasis. World J Surg 2013;37:1133–1140.

    Article  PubMed  Google Scholar 

  6. Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children. World J Gastroenterol 2010;16:490–495.

    Article  PubMed Central  PubMed  Google Scholar 

  7. De Angelis P, Foschia F, Romeo E, Caldaro T, Rea F, di Abriola GF, et al. Role of endoscopic retrograde cholangiopancreatography in diagnosis and management of congenital choledochal cysts: 28 pediatric cases. J Pediatr Surg 2012;47:885–888.

    Article  PubMed  Google Scholar 

  8. Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793–801.

    Article  CAS  PubMed  Google Scholar 

  9. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management an attempt at consensus. Gastrointest Endosc 1991;37:383–393.

    Article  CAS  PubMed  Google Scholar 

  10. Pannu DS, Draganov PV. Therapeutic endoscopic retrograde cholangiopancreatography and instrumentation. Gastrointest Endosc Clin N Am 2012;22:401–416.

    Article  PubMed  Google Scholar 

  11. NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 2002;19:1–26.

  12. Al-Rashdan A, LeBlanc J, Sherman S, McHenry L, DeWitt J, Al-Haddad M. Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: a tertiary care center experience. J Pediatr Gastroenterol Nutr 2010;51:718–722.

    Article  PubMed  Google Scholar 

  13. Pfau PR, Chelimsky GG, Kinnard MF, Sivak MV Jr, Wong RC, Isenberg GA, et al. Endoscopic retrograde cholangiopancreatography in children and adolescents. J Pediatr Gastroenterol Nutr 2002;35:619–623.

    Article  PubMed  Google Scholar 

  14. Cheng CL, Fogel EL, Sherman S, McHenry L, Watkins JL, Croffie JM, et al. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report. J Pediatr Gastroenterol Nutr 2005;41:445–453.

    Article  PubMed  Google Scholar 

  15. Currò G, Meo A, Ippolito D, Pusiol A, Cucinotta E. Asymptomatic cholelithiasis in children with sickle cell disease: early or delayed cholecystectomy? Ann Surg 2007;245:126–129.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Al-Salem AH, Issa H. Laparoscopic cholecystectomy in children with sickle cell anemia and the role of ERCP. Surg Laparosc Endosc Percutan Tech 2012;22:139–142.

    Article  PubMed  Google Scholar 

  17. Issa H, Al-Haddad A, Al-Salem A. Sickle cell cholangiopathy: an endoscopic retrograde cholangiopancreatography evaluation. World J Gastroenterol 2009;15:5316–5320.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Teng R, Yokohata K, Utsunomiya N, Takahata S, Nabae T, Tanaka M. Endoscopic retrograde cholangiopancreatography in infants and children. J Gastroenterol 2000;35:39–42.

    Article  CAS  PubMed  Google Scholar 

  19. Otto AK, Neal MD, Slivka AN, Kane TD. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases. Surg Endosc 2011;25:2536–2540.

    Article  PubMed  Google Scholar 

  20. Meagher S, Yusoff I, Kennedy W, Martel M, Adam V, Barkun A. The roles of magnetic resonance and endoscopic retrograde cholangiopancreatography (MRCP and ERCP) in the diagnosis of patients with suspected sclerosing cholangitis: a costeffectiveness analysis. Endoscopy 2007;39:222–228.

    Article  CAS  PubMed  Google Scholar 

  21. Linhares MM, Coelho RD, Szejnfeld J, Goldman SM, Gonzalez AM, Szejnfeld D, et al. Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation. Acta Cir Bras 2010;25:249–256.

    Article  PubMed  Google Scholar 

  22. Paris C, Bejjani J, Beaunoyer M, Ouimet A. Endoscopic retrograde cholangiopancreatography is useful and safe in children. J Pediatr Surg 2010;45:938–942.

    Article  PubMed  Google Scholar 

  23. Taj MA, Leghari A, Qureshi S, Ghazanfar S, Niaz SK, Quraishy MS. Endoscopic retrograde cholangiopancreatography: a therapeutic modality in children and adolescents. J Pak Med Assoc 2012;62:98–101.

    PubMed  Google Scholar 

  24. Vegting IL, Tabbers MM, Taminiau JA, Aronson DC, Benninga MA, Rauws EA. Is endoscopic retrograde cholangiopancreatography valuable and safe in children of all ages? J Pediatr Gastroenterol Nutr 2009;48:66–71.

    Article  CAS  PubMed  Google Scholar 

  25. Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am 2010;39:157–169.

    Article  PubMed  Google Scholar 

  26. Prasil P, Laberge JM, Barkun A, Flageole H. Endoscopic retrograde cholangiopancreatography in children: a surgeon’s perspective. J Pediatr Surg 2001;36:733–735.

    Article  CAS  PubMed  Google Scholar 

  27. Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004;60:367–371.

    Article  PubMed  Google Scholar 

  28. Green JA, Scheeres DE, Conrad HA, Cloney DL, Schlatter MG. Pediatric ERCP in a multidisciplinary community setting: experience with a fellowshiptrained general surgeon. Surg Endosc 2007;21:187–192.

    Article  Google Scholar 

  29. Jowell PS, Baillie J, Branch MS, Affronti J, Browning CL, Bute BP. Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med 1996;125:983–989.

    Article  CAS  PubMed  Google Scholar 

  30. Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 2006;101:892–897.

    Article  PubMed  Google Scholar 

  31. Schlup MM, Williams SM, Barbezat GO. ERCP: a review of technical competency and workload in a small unit. Gastrointest Endosc 1997;46:48–52.

    Article  CAS  PubMed  Google Scholar 

  32. Rocca R, Castellino F, Daperno M, Masoero G, Sostegni R, Ercole E, et al. Therapeutic ERCP in paediatric patients. Dig Liver Dis 2005;37:357–362.

    Article  CAS  PubMed  Google Scholar 

  33. Iqbal CW, Baron TH, Moir CR, Ishitani MB. Post-ERCP pancreatitis in pediatric patients. J Pediatr Gastroenterol Nutr 2009;49:430–434.

    Article  PubMed  Google Scholar 

  34. Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781–1788.

    Article  PubMed  Google Scholar 

  35. Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 2009;104:31–40.

    Article  PubMed  Google Scholar 

  36. Testoni PA, Vailati C, Giussani A, Notaristefano C, Mariani A. ERCP-induced and non-ERCP-induced acute pancreatitis: Two distinct clinical entities with different outcomes in mild and severe form? Dig Liver Dis 2010;42:567–570.

    Article  PubMed  Google Scholar 

  37. Rabenstein T, Schneider HT, Nicklas M, Ruppert T, Katalinic A, Hahn EG, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointest Endosc 1999;50:628–636.

    Article  CAS  PubMed  Google Scholar 

  38. Moon SH, Kim MH. Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis From divination to science. World J Gastroenterol 2013;19:631–637.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Dumonceau JM, Andriulli A, Deviere J, Mariani A, Rigaux J, Baron TH, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010;42:503–515.

    Article  PubMed  Google Scholar 

  40. Tipnis NA, Werlin SL. The use of magnetic resonance cholangiopancreatography in children. Curr Gastroenterol Rep 2007;9:225–229.

    Article  PubMed  Google Scholar 

  41. Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancreatography of biliary system abnormalities in children. Clin Imaging 2007;31:93–101.

    Article  PubMed  Google Scholar 

  42. Huang CT, Lee HC, Chen WT, Jiang CB, Shih SL, Yeung CY. Usefulness of magnetic resonance cholangiopancreatography in pancreatobiliary abnormalities in pediatric patients. Pediatr Neonatol 2011;52:332–336.

    Article  PubMed  Google Scholar 

  43. Dong Q, Jiang BX, Jiang Z, Zhang H, Zhao N, Jiang XM, et al. Management of congenital choledochal cyst complicated by biliary anomalies and aberrant bile duct. World J Pediatr 2006;2:133–138.

    Google Scholar 

  44. Chavhan GB, Babyn PS, Manson D, Vidarsson L. Pediatric MR cholangiopancreatography: principles, technique, and clinical applications. Radiographics 2008;28:1951–1962.

    Article  PubMed  Google Scholar 

  45. Jorgensen JE, Waljee AK, Volk ML, Sonnenday CJ, Elta GH, Al-Hawary MM, et al. Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis. Gastrointest Endosc 2011;73:955–962.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Post-Graduate Program of Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil

    Carlos O. Kieling, Cristiane Hallal & Helena A. S. Goldani

  2. Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil

    Carlos O. Kieling, Cristiane Hallal, Camila O. Spessato, Luciana M. Ribeiro & Helena A. S. Goldani

  3. Endoscopy Service, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil

    Helenice Breyer & Ismael Maguilnik

Authors
  1. Carlos O. Kieling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristiane Hallal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camila O. Spessato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luciana M. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helenice Breyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helena A. S. Goldani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ismael Maguilnik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cristiane Hallal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kieling, C.O., Hallal, C., Spessato, C.O. et al. Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience. World J Pediatr 11, 154–159 (2015). https://doi.org/10.1007/s12519-014-0518-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-014-0518-5

Key words

Search

Navigation