Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):64-67. doi: 10.1097/MPG.0000000000002102.
Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists.
Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables.
One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004).
Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.
患有胆总管结石的儿童经常在没有内镜逆行胰胆管造影（ERCP）术专家的三级儿童医院接受治疗。我们假设，在没有 ERCP 术专家的医院接受治疗的患者的住院时间（LOS）会比有 ERCP 术专家的患者长。
对 3 家三级儿童医院 10 年来接受胆囊切除术和 ERCP 的患者进行了病历回顾。排除了创伤和复杂胰腺炎患者。使用 Wilcoxon 秩和检验对连续变量和 Fisher 确切检验对分类变量进行比较，比较需要和不需要 ERCP 转院的患者。
164 例患者因疑似胆总管结石而行 ERCP：转院组 79 例（48%），未转院组 85 例（52%）。需要转院的患者 LOS 中位数较长（7 天 vs 5 天，P<0.0001）。三分之一（34%）的转院患者行磁共振胰胆管造影术，而无需转院的患者仅为 7%（P<0.0001）。在 123 例在胆囊切除术前行 ERCP 的患者中，53%（66/123）需要转院，47%（57/123）不需要转院。转院组患者的 LOS 中位数明显较长（P<0.0001），入院至 ERCP 之间的天数更多（P<0.0001），ERCP 至手术之间的天数更多（P=0.0004）。
总体而言，在入院机构行 ERCP 的患者 LOS 明显较短。在没有可用 ERCP 术专家的医院行 ERCP 术前胆囊切除术的患者 LOS 较长。需要更多接受过适当培训以在儿童中进行 ERCP 的儿科术专家。
