The following is a summary of “Pediatric ERCP: Factors for Success and Complication—A 17-Year, Multisite Experience,” published in the September 2023 issue of Pediatrics by Lorio, et al.
Endoscopic retrograde cholangiopancreatography (ERCP) has seen increased utilization within the pediatric population. However, the absence of dedicated research for pediatric patients has compelled endoscopists to extrapolate adult risk factors and preventive strategies onto children. For a retrospective, multisite study, researchers sought to discern the risk factors for adverse events, procedure failure, and extended courses in pediatric patients undergoing ERCP.
Pediatric patients who underwent ERCP at the academic centers were identified through electronic medical record queries to achieve the objective. Pre-procedure and post-procedure data were meticulously gathered, and adverse events related to ERCP were categorized following the criteria established by Cotton et al. in 2010.
Over a span from January 2004 to January 2021, 287 children underwent a total of 716 ERCP procedures. Notably, the procedure success rate reached 95.5%, with no recorded fatalities but an adverse event rate of 12.7%. Notably, younger age was correlated with heightened case complexity, increased adverse events, and a greater likelihood of requiring repeat ERCP. The case complexity score demonstrated a significant correlation with both extended procedure duration (P < 0.001) and an elevated incidence of adverse events (tau 0.24, P < 0.01). Adverse events were more likely to occur following stent removal and pancreatic stenting. Pancreatitis, pancreatic divisum, and pancreatic stricture/stenosis were linked to increased adverse events and repeat ERCP procedures.
In summary, the adverse event rates for pediatric ERCP patients surpass those observed in adults. The complexity grading system originally proposed by Cotton et al. seems to be applicable to pediatric patients. Notably, young age and interventions affecting the pancreatic duct emerge as factors associated with adverse ERCP outcomes in the pediatric population. The study provided critical insights into the risks and outcomes of ERCP in pediatric patients, underlining the importance of dedicated research in the specific population.