ERCP in infants, children and adolescents is feasible and safe – results from a tertiary care center

Indications for ERCP in children differ from adults, and concerns about side effects limit its use even in high volume centers. We retrospectively analyzed indications, effectiveness, limitations, and side effects of ERCPs in children< 18 years.

From Jan 2012-Mar 2015, 54 ERCPs (median 1, range 1 – 7) were performed in 31 children (mean age 7.6 ± 6.1yrs; median weight 22 kg, range 3.3 – 143). Indications were suspected choledocholithiasis (n = 13), postoperative complications (15), ductal anomalies (14), tumors (10), and PSC (2). Ultrasonography and/or cross sectional imaging was available for all patients. All patients were followed up ≥3 d.

Therapeutic ERCP was performed in 36 children, diagnostic in 18, by adult ERCP expert endoscopists. Endoscopic papillotomy was performed in 16/54 examinations.

Successful intervention (defined as accurate diagnosis and/or adequate therapy) was possible in 87.0% (47/54 ERCPs), and was more often achieved in older children (mean age 10.9 vs. 4.2 years, median weight 34.0 vs. 8.3 kg). Standard duodenscopes were used in children > 20 kg BW, smaller diameter duodenoscopes (diameter 7.5 mm) in smaller children.

5 complications (5/54, 9.3%) included 4 cases of mild pancreatitis (7.4% PEP rate; incl. 2 pts. with aggravation of preexisting pancreatitis) and 1 aggravation of cholangitis in PSC despite antimicrobial prophylaxis. PEP was noted in 0/6 children with protective pancreatic stent vs. 4/43 without pancreatic stent. All complications were managed conservatively. No complications were attributed to mechanical stress on the GI tract.

ERCP in children only accounted for 3.3% of our ERCP caseload. Failed cannulation was associated with small dimensions of young children. Accessories for small caliber duodenoscopes are limited, as is navigation at the papilla in babies. Complications rates were similar to adults. Rectal NSAIDs in children were not yet standard in our cohort, but may be considered. Protective pancreatic stents were helpful but necessitate endoscopy for removal or proof of spontaneous passage. Endoscopists must be aware of different spectrum of diseases, and close collaboration between endoscopists and pediatricians is mandatory. In summary, ERCP in children appears to be safe and effective in selected indications.