Keane Margaret G, Kumar Mayur, Cieplik Natascha, Thorburn Douglas, Johnson Gavin J, Webster George J, Chapman Michael H, Lindley Keith J, Pereira Stephen P
Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK.
Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK.
BMC Pediatr. 2018 Feb 9;18(1):42. doi: 10.1186/s12887-017-0959-9.
In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series.
All patients <18 years undergoing an ERCP or EUS between January 1992-December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases.
Ninety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1-4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy.
ERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.
在成人中，内镜逆行胰胆管造影术（ERCP）和内镜超声检查（EUS）是评估和治疗许多肝胆胰（HPB）疾病的标准方法。HPB疾病在儿童中的诊断频率越来越高，但关于ERCP和EUS在该人群中的作用及其结果的信息仍然有限。因此，本研究的目的是描述一家大型三级转诊HPB中心的儿科ERCP和EUS经验，并系统地将结果与其他已发表系列进行比较。
纳入1992年1月至2014年12月期间接受ERCP或EUS检查的所有18岁以下患者。记录所有病例的手术指征、技术成功率、手术不良事件和再次干预情况。
90名儿童接受了111次手术（87次ERCP和24次EUS）。53%（48名）为女性，中位年龄为14岁（范围：3个月至17岁）。手术在全身麻醉（n = 48）或清醒镇静（n = 63）下进行。ERCP的常见指征包括慢性或复发性胰腺炎和胆道梗阻。患者经常有多种合并症，中位美国麻醉医师协会（ASA）分级为2级（范围1 - 4级）。进行的治疗性手术包括胆管或胰管括约肌切开术、胆总管或胰管结石清除术、胆管或胰管支架置入术、EUS引导下细针穿刺抽吸术以及胰腺液体积聚的内镜经壁引流术。ERCP术后未报告不良事件，但EUS引导下囊肿肠造口术后有1例并发症需要手术治疗。
在大型HPB中心对儿童和青少年进行ERCP和EUS时，技术成功率高且不良事件发生率低。
