Comparison of performance and safety of endoscopic retrograde cholangiopancreatography across pediatric age groups

Background and Study Aim: Endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be overall effective and safe in children, but its performance characteristics and safety profile have not been specifically evaluated according to age. We aim to compare the indications, findings, interventions, and safety outcomes of ERCP across pediatric age groups. Methods: A retrospective cross-sectional study of pediatric patients (ages 17 or below) who underwent ERCP between October 1998 and April 2011 at a tertiary-care academic center. Data on indications, findings, technical success, and adverse events of ERCP were collected and compared according to age groups (0-6, 7-12, or 13-17 years). Results: There were 289 procedures performed in 154 children (mean age, 11.5 years). The number of patients undergoing ERCP increased with age; teenagers constituted the largest group (52.6 %) and had the most procedures (49.8 %). Children aged 0-6 years had an equal distribution of biliary and pancreatic cases; children aged 7-12 years had predominantly pancreatic indications. Most procedures in teenagers were for biliary indications. Overall, the technical success rates of ERCPs were similar across age groups (P = 0.661). Seventeen adverse events (5.9 % of procedures) were identified: post-procedure pancreatitis (12 cases; 4.2 %), hypoxia (3; 1.0 %), and hemorrhage (2; 0.7 %). The youngest group had more adverse events (12.0 %, compared to 6.3 and 2.1 % in other groups; P = 0.049), mostly due to mild pancreatitis. Conclusion: ERCP is generally safe in the pediatric population, although the risk of mild post-procedure pancreatitis may be higher among the youngest children.