How Successful Are Pediatric GIs at Completing Pediatric ERCPs

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DM Troendle et al. JPGN 2022; 75: 755-760. Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative

In this prospective cohort study with 1124 ERCPs (n=857 patients), 92% were performed in 15 centers by a pediatric gastroenterologist. Key findings:

  • Common indications included choledocholithiasis (41%), improved drainage for chronic pancreatitis (14%), stricture (17%), plan for sphincterotomy (5%) and bile leak (3%)
  • Procedures were technically successful in 90.5%
  • Only 26 cases (2.3%) were completed in infants (<1 yr) and 35 cases (3.1%) in 1-3 yrs. In these age groups, technical success was much lower: 80% (all children 3 yrs of age or less). Similarly, technical success was 76% in those <10 Kg.
  • ASGE difficulty grades 1 & 2 had success rates of 94% compared to 86% for grades 3 & 4. (ASGE classification adds one level in those 3 years of age or younger). ASGE grade 1, 2, 3 & 4 accounted for 13%, 47%, 34%, and 5% respectively.
  • Adverse effects were reported in 9.5%, though most were mild. Three perforations and 5 bouts of cholangitis were reported; however, there were no deaths or serious morbidity reported.
  • Post-ERCP pancreatitis (PEP) prophylaxis was associated with a decreased odds of PEP (OR 2.1, P=<0.01); among specific PEP prophylaxis, only rectal indomethacin neared statistical significance (P=0.07)

My take: Well-trained pediatric gastroenterologists are capable of doing high-quality ERCPs. In very young children, technical success is more difficult and probably requires the highest skillset.

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