Garg Love, Vaidya Arun, Kale Aditya, Gopan Amrit, Ansari Abu, Patra Biswa Ranjan, Shukla Akash
Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India.
Indian J Gastroenterol. 2024 Oct;43(5):1037-1044. doi: 10.1007/s12664-023-01498-7. Epub 2024 Feb 17.
There is sparse data from India on indications, technical success, safety and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) using standard adult duodenoscope in the pediatric population.
Retrospective analysis of prospectively maintained electronic endoscopy and clinical database was performed to identify pediatric patients (age ≤ 18 years) who underwent ERCP between January 2017 and December 2022. Demographics and procedural details including indications, cholangio-pancreatogram findings, endotherapy type performed, technical and clinical success and complications were noted.
As many as 150 pediatric patients were included of whom 88 had pancreatic (mean age-13.7 years) and 62 had biliary disease (mean age- 14.9 years). Common pancreatic ERCP indications were chronic pancreatitis (n = 45 [51.1%]), pancreatic duct disruption fistula (n = 21 [23.9%]) and recurrent acute pancreatitis (n = 16 [18.2%]). Among biliary indications were choledocholithiasis (n = 29 [46.8%]), benign bile duct strictures (n = 13 [21%]), bile duct injury/leak and biliary stent removal (n = 7 [11.3%]) , choledochal cyst (n = 5 [8.1%]) and pancreatic mass causing biliary compression (n = 1 [1.6%]). Technical success in pancreatic and biliary ERCP was 94.3% and 95.2%, respectively, and clinical success was 84.1% and 93.5%, respectively. Most common complications following pancreatic ERCPs were acute pancreatitis (n = 9 [10.2%]) (mild = 5, moderate = 4) patients and post sphincterotomy bleed in one (1.1%). Among biliary ERCPs, post ERCP pancreatitis was seen in (n = 3 [4.8%]) (mild = 2, moderate = 1).
ERCP can be safely and effectively performed in children using standard duodenoscope. Chronic pancreatitis, choledocholithiasis and pancreatic divisum are common pediatric ERCP indications.
在印度，关于使用标准成人十二指肠镜对儿科患者进行内镜逆行胰胆管造影术（ERCP）的适应证、技术成功率、安全性和结果的数据稀少。
对前瞻性维护的电子内镜和临床数据库进行回顾性分析，以确定2017年1月至2022年12月期间接受ERCP的儿科患者（年龄≤18岁）。记录人口统计学和手术细节，包括适应证、胰胆管造影结果、所进行的内镜治疗类型、技术和临床成功率以及并发症。
共纳入150例儿科患者，其中88例患有胰腺疾病（平均年龄13.7岁），62例患有胆道疾病（平均年龄14.9岁）。胰腺ERCP的常见适应证为慢性胰腺炎（n = 45 [51.1%]）、胰管破裂瘘（n = 21 [23.9%]）和复发性急性胰腺炎（n = 16 [18.2%]）。胆道适应证包括胆总管结石（n = 29 [46.8%]）、良性胆管狭窄（n = 13 [21%]）、胆管损伤/渗漏和胆道支架取出（n = 7 [11.3%]）、胆总管囊肿（n = 5 [8.1%]）以及引起胆道压迫的胰腺肿块（n = 1 [1.6%]）。胰腺和胆道ERCP的技术成功率分别为94.3%和95.2%，临床成功率分别为84.1%和93.5%。胰腺ERCP后最常见的并发症是急性胰腺炎（n = 9 [10.2%]）（轻度 = 5例，中度 = 4例）患者，1例（1.1%）出现括约肌切开术后出血。在胆道ERCP中，ERCP后胰腺炎见于（n = 3 [4.8%]）（轻度 = 2例，中度 = 1例）。
使用标准十二指肠镜可在儿童中安全有效地进行ERCP。慢性胰腺炎、胆总管结石和胰腺分裂症是儿科ERCP的常见适应证。
