小儿患者内镜逆行胰胆管造影相关不良事件：10 年单中心回顾。
ERCP-Related adverse events in pediatric patients: a 10-years single-site review.
机构信息
Hebei Medical University, Shijiazhuang, Hebei, China.
Departments of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
出版信息
Pediatr Surg Int. 2024 Jul 17;40(1):199. doi: 10.1007/s00383-024-05784-z.
PURPOSE
This retrospective analysis aimed to assess the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients by examining ERCP-related adverse events (AEs) occurring over a decade at a single center.
METHODS
Pediatric patients under 18 years old who underwent ERCP at the Second Hospital of Hebei Medical University from 1/2013 to 11/2023 were included. ERCP-related AEs were defined according to ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Clinical data of patients experiencing ERCP-related AEs were obtained from electronic medical records for analysis.
RESULTS
Over the past decade, a total of 76 pediatric patients underwent 113 ERCP procedures, including 26 patients who underwent repeat ERCP, totaling 63 procedures. There were 32 males and 44 females, with a median age of 13 years (range 3 years and 5 months-17 years and 9 months). Among all ERCP procedures, 14 (12.4%) were diagnostic and 99 (87.6%) were therapeutic, with a 100% success rate. 16 cases (14.2%) of ERCP-related AEs, all post-ERCP pancreatitis (PEP), were observed, while no other AEs defined by ESGE such as bleeding, perforation, cholangitis, cholecystitis, or sedation-related events were noted. Additionally, 23 cases (20.4%) of ERCP-related AEs not included in the ESGE definition were observed, including post-ERCP abdominal pain in 20 cases (17.7%), post-ERCP nausea and vomiting in 2 cases (1.8%), and unplanned reoperation in 1 case (0.9%). In the 26 cases of pediatric patients who underwent repeat ERCP, we observed that AEs occurred in 15 cases (57.7%) during their initial ERCP, which was much higher than the overall average level.
CONCLUSIONS
Post-ERCP abdominal pain and PEP are the most common ERCP-related AEs in pediatric patients, while severe AEs such as bleeding and perforation are rare. The incidence of AEs after initial ERCP in pediatric patients who received repeat ERCP is higher than the overall average level. Based on our center's experience, we believe that ERCP can be safely performed in children over 3 years old with biliary and pancreatic diseases and obtain reliable clinical benefits. However, active monitoring and management of ERCP-related AEs are essential to improve the clinical outcomes of pediatric ERCP.
目的
本回顾性分析旨在评估单中心 10 多年来内镜逆行胰胆管造影（ERCP）相关不良事件（AE）在儿科患者中的可行性和安全性。
方法
纳入 2013 年 1 月至 2023 年 11 月在河北医科大学第二医院接受 ERCP 的 18 岁以下儿科患者。ERCP 相关 AE 根据 ERCP 相关不良事件：欧洲胃肠道内镜学会（ESGE）指南进行定义。从电子病历中获取经历 ERCP 相关 AE 患者的临床数据进行分析。
结果
在过去的十年中，共有 76 名儿科患者接受了 113 次 ERCP 检查，其中 26 名患者接受了重复 ERCP，共计 63 次。其中男 32 例，女 44 例，中位年龄 13 岁（3 岁 5 个月至 17 岁 9 个月）。所有 ERCP 中，诊断性 14 例（12.4%），治疗性 99 例（87.6%），成功率 100%。观察到 16 例（14.2%）与 ERCP 相关的 AE，均为内镜逆行胰胆管造影后胰腺炎（PEP），未见 ESGE 定义的其他 AE，如出血、穿孔、胆管炎、胆囊炎或镇静相关事件。此外，观察到 23 例（20.4%）未纳入 ESGE 定义的与 ERCP 相关的 AE，包括 20 例（17.7%）ERCP 后腹痛、2 例（1.8%）ERCP 后恶心呕吐和 1 例（0.9%）计划外再次手术。在 26 例接受重复 ERCP 的儿科患者中，我们观察到初次 ERCP 中 15 例（57.7%）发生 AE，明显高于总体平均水平。
结论
内镜逆行胰胆管造影后腹痛和 PEP 是儿科患者中最常见的 ERCP 相关 AE，而出血和穿孔等严重 AE 则很少见。接受重复 ERCP 的儿科患者初次 ERCP 后 AE 的发生率高于总体平均水平。根据我们中心的经验，我们认为对于患有胆道和胰腺疾病的 3 岁以上儿童，可以安全地进行 ERCP，并获得可靠的临床获益。然而，积极监测和管理 ERCP 相关 AE 对于改善儿科 ERCP 的临床结局至关重要。
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