Green J A, Scheeres D E, Conrad H A, Cloney D L, Schlatter M G
Department of Surgery, Grand Rapids General Surgery Residency, Michigan State University-College of Human Medicine, 221 Michigan NE, Suite 200A, Grand Rapids, Michigan 49503, USA.
Surg Endosc. 2007 Dec;21(12):2187-92. doi: 10.1007/s00464-007-9334-5. Epub 2007 May 19.
Endoscopic retrograde cholangiopancreatography (ERCP) has been used to evaluate and treat pancreaticobiliary disorders and trauma in the pediatric population. Still representing a small percentage of total pediatric endoscopies, this procedure has been performed most commonly by a small subset of adult and pediatric gastroenterologists at quaternary referral centers.
In this study, we present a review of one fellowship-trained general surgeon's experience with pediatric ERCP in a teaching community pediatric hospital for the purpose of comparison with national series.
All ERCPs performed by one general surgeon as part of a multidisciplinary team over a 5-year period in patients aged 16 years or less were reviewed. Success and complication rates were compared between our series and published pediatric and adult series using Fisher's exact test. Comparisons were made of indications, type of anesthesia, final diagnosis, and therapeutic interventions to ensure similar study populations. A total of 26 ERCPs were performed in 19 patients ranging from 7 to 16 years old. Therapeutic procedures included sphincterotomy (11), stent placement (7), stone removal (3), and dilation (2). In one case, stone removal and stent placement were performed in conjunction with pancreatic lithotripsy. In two cases the involved duct was not visualized. There were no instances of pancreatitis, bleeding, or perforation related to ERCP.
When compared with published series, our data demonstrated no significant difference in success or complication rates. Our study demonstrates that pediatric ERCP can be performed by fellowship-trained general surgeons with success and complication rates comparable to accepted standards. Integration of the ERCP-trained general surgeon into the pediatric team is a potential asset in the care of pediatric patients with pancreaticobiliary disorders.
内镜逆行胰胆管造影术（ERCP）已用于评估和治疗儿科患者的胰胆管疾病及创伤。该手术在儿科内镜检查总数中所占比例仍然较小，主要由四级转诊中心的一小部分成人及儿科胃肠病学家进行。
在本研究中，我们回顾了一位接受过专科培训的普通外科医生在一家教学型社区儿科医院进行儿科ERCP的经验，以便与全国性系列研究进行比较。
回顾了一位普通外科医生作为多学科团队一员在5年期间为16岁及以下患者进行的所有ERCP手术。使用Fisher精确检验比较了我们的系列研究与已发表的儿科及成人系列研究的成功率和并发症发生率。对适应证、麻醉类型、最终诊断和治疗干预措施进行了比较，以确保研究人群相似。共对19例年龄在7至16岁的患者进行了26次ERCP手术。治疗性操作包括括约肌切开术（11例）、支架置入术（7例）、取石术（3例）和扩张术（2例）。1例患者在进行胰管碎石术的同时进行了取石和支架置入。2例患者的相关胆管未显影。未发生与ERCP相关的胰腺炎、出血或穿孔病例。
与已发表的系列研究相比，我们的数据显示成功率和并发症发生率无显著差异。我们的研究表明，接受过专科培训的普通外科医生可以成功进行儿科ERCP，其成功率和并发症发生率与公认标准相当。将接受过ERCP培训的普通外科医生纳入儿科团队，对于治疗患有胰胆管疾病的儿科患者而言是一项潜在的优势。
