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. 2018 Feb 9;18(1):42.
doi: 10.1186/s12887-017-0959-9.

Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review

Margaret G Keane  1 , Mayur Kumar  2 , Natascha Cieplik  1 , Douglas Thorburn  1 , Gavin J Johnson  2 , George J Webster  2 , Michael H Chapman  2 , Keith J Lindley  3 , Stephen P Pereira  4
Affiliations

Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review

Margaret G Keane et al. BMC Pediatr. .

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.

Keywords: Biliary leak; Choledocholithiasis; Chronic pancreatitis; Cystic lesion of the pancreas; Endoscopic retrograde Cholangiopancreaticography (ERCP); Endoscopic ultrasound (EUS); Paediatric; Pancreatic fluid collection; Primary sclerosing cholangitis; Transmural drainage.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed against the UK Health Research Authority definitions of research and was deemed to primarily be an evaluation of clinical service and therefore did not require formal ethical approval for the study or access to the clinical databases used in the study [35]. It was registered as a clinical audit project at University College London Hospitals. All patients received standard treatment in accordance with local and national guidelines, where available.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Systematic literature review flowchart
Fig. 2
Fig. 2
Reported adverse events compared to number of cases reported in each published series in the systematic review for paediatric ERCP
Fig. 3
Fig. 3
Number of ERCP and EUS procedures performed per year during the study period
Fig. 4
Fig. 4
Therapeutic interventions performed for each diagnostic indication
See this image and copyright information in PMC

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