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Medline ® Abstract for Reference 3

of 'ERCP in children: Technique, success and complications'

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ERCP in the evaluation of abdominal pain in children.
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Dua K, Miranda A, Santharam R, Ramanujam S, Werlin S
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Gastrointest Endosc. 2008;68(6):1081.
 
BACKGROUND: ERCP is feasible and safe in the pediatric population. Its utility in the evaluation of children with pain suggestive of a pancreatobiliary origin without objective findings compared with those with abnormal biochemical and/or imaging studies is not well known.
OBJECTIVE: To determine the utility of ERCP in the diagnosis and management of children seen with abdominal pain.
DESIGN: Retrospective review.
SETTING: One tertiary center.
PATIENTS: All children who underwent ERCP at one tertiary center from 1994 to 2004.
METHOD: An endoscopy database was used. Data sets with regard to indications, technical success, complications, and outcomes were evaluated. BeforeERCP, children with abdominal pain were categorized into 2 groups: group I, those with objective findings, namely abnormal biochemistry and/or abnormal imaging studies; group II, those who had abdominal pain without objective findings.
MAIN OUTCOME MEASUREMENTS: ERCP success and failure rates, findings, interventions, complications, and outcomes were determined. Data were compared between group I and group II.
RESULTS: A total of 185 consecutive children with abdominal pain who underwent ERCP were identified (131 in group I and 54 in group II). ERCP technical success was achieved in 98%. In group I, ERCP identified a cause for abdominal pain in 93 of 129 children (72%). Fifty-four of 93 patients (58%) in this group underwent endoscopic intervention with resolution of pain. In group II, a cause for abdominal pain was identified in 30 of 53 children (56%)(P<.025 compared with group I). Fourteen of 30 patients (47%) in this group underwent endoscopic intervention with resolution of pain. Complications noted were mild pancreatitis in two and self-limited bleeding in one.
LIMITATIONS: A retrospective study, one tertiary center where the majority of the ERCPs were performed by one experienced operator.
CONCLUSIONS: ERCP in children with abdominal pain suggestive of a pancreatobiliary origin has a favorable risk:benefit ratio.
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Division of Gastroenterology and Hepatology, Froedtert Memorial Hospital, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
PMID