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Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience
Carlos O Kieling, Cristiane Hallal, Camila O Spessato, Luciana M Ribeiro, Helenice Breyer, Helena AS Goldani, Ismael Maguilnik
Porto Alegre-RS, Brazil
Author Affiliations: Post-Graduate Program of Sciences in Gastro-enterology and Hepatology, Universidade Federal do Rio Grande do Sul (Kieling CO, Hallal C, Goldani HAS); Pediatric Gastroenterology Unit, Hospital de Cl¨ªnicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil (Kieling CO, Hallal C, Spessato CO, Ribeiro LM, Goldani HAS); Endoscopy Service, Hospital de Cl¨ªnicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil (Breyer H, Maguilnik I)
Corresponding Author: Cristiane Hallal, Rua Ramiro Barcelos 2350, Porto Alegre-RS 90035-903, Brazil (Tel: 55-51-33597859; Fax: 55-51-33597859; Email: cris.hallal@yahoo.com)
doi:10.1007/s12519-014-0518-5
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¡À3.9 vs. 9.9¡À4.9 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.
World J Pediatr 2015;11(2):154-159
Key words: adolescents;
cholangiopancreatography;
endoscopic retrograde
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