ERCP in children: Technique, success and complications
- Moises Guelrud, MD
Moises Guelrud, MD
- Clinical Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- Douglas A Howell, MD, FASGE, FACG
Douglas A Howell, MD, FASGE, FACG
- Section Editor — EUS/ERCP
- Assistant Clinical Professor of Medicine, Tufts Medical School Director,
- Pancreaticobiliary Center Director, Advanced Interventional Endoscopy Fellowship, Maine Medical Center
Experience with endoscopic retrograde cholangiopancreatography (ERCP) in children has been limited due to multiple factors, including the relatively low incidence of diseases requiring ERCP in this age group, the impression that the procedure is technically difficult in children, and because the indications and safety of ERCP in children have not been well defined. As a result, patients are generally referred to a tertiary care facility or to adult endoscopists who perform a high volume of procedures.
This topic review will focus on the technical aspects of performing ERCP in children. Indications for ERCP in children are discussed separately. (See "ERCP for biliary disease in children" and "ERCP for pancreatic disease in children".)
PATIENT PREPARATION AND SEDATION
Because most ERCP procedures in children are performed by adult gastroenterologists, a close working collaboration between an adult and a pediatric gastroenterologist is important during patient preparation and the procedure itself. The preparation and sedation of a child undergoing ERCP is similar to that used for upper gastrointestinal endoscopy. The procedure should be explained to the child in a manner appropriate for the age and level of intellectual and emotional development.
The endoscopist must choose between conscious sedation and general anesthesia after considering the pertinent risks and taking into account personal skill and experience and the expected complexity of the procedure. A state of deep sedation from which the patient is not easily aroused is often required, since young children and some adolescents cannot fully cooperate with procedures under lesser degrees of conscious sedation. Most children can be sedated adequately with a combination of meperidine or fentanyl and diazepam or midazolam. Children frequently require much higher doses of midazolam on a milligram per kilogram basis than adults. In occasions, children can also be sedated with propofol with anesthesia support.
Postprocedure monitoring is the same as for other endoscopic procedures requiring sedation. Personnel with appropriate training in pediatric sedation and monitoring are required for either conscious sedation or general anesthesia.
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