Efficacy of ERCP in infancy and childhood

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a well established diagnostic and therapeutic tool in adult and pediatric patients. Because of its inherent risks we analysed our series in an attempt to better define the diagnostic and therapeutic roles of ERCP and its effectiveness in children.

METHODS: All ERCPs performed in our department during a 10-year period in patients age 14 years and under were reviewed retrospectively. Indications, diagnostic findings, therapeutic interventions and final outcome were documented.

RESULTS: A total of 61 procedures were performed on 47 patients whose median age was 8.56 years. ERCP was successful in 53 of 61 interventions (89%) with a complication rate of 6%. Thirty patients underwent diagnostic ERCP. In these a pathological diagnosis was established in 57%. In patients without morphological changes in ultrasound or magnet resonance imaging ERCP failed to set diagnosis too. Seventeen patients had therapeutic ERCPs. All of these interventions were performed with similar or better outcome than in adults.

CONCLUSION: Indications for diagnostic ERCP are morphologic biliary or pancreatic duct disorders, but only where higher resolution imaging is necessary for therapeutic decisions. Without morphologic changes on ultrasound or magnetic resonance imaging we rarely see any indication for diagnostic ERCP. Efficacy of therapeutic ERCP in childhood is similar or even better to that in adults. Prognoses are directly dependent from the basic disease of the patient.