Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study
Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study
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DOI：
10.1055/a-1209-0155
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发表时间：
2021-06-01
期刊：
影响因子：
9.3
通讯作者：
Chevaux, Jean-Baptiste
中科院分区：
文献类型：
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作者：
Mercier, Clemence;Pioche, Mathieu;Chevaux, Jean-Baptiste
介绍：本回顾性多中心研究的目的是评估法国和比利时中心儿童内镜逆行胰胆管造影术（ERCP）的技术成功率和不良事件。方法回顾性纳入2008年1月至2019年3月在15家三级医院接受ERCP的所有1天至17岁儿童。结果271例患儿共行470次ERCP检查。我们72%的患者（340/470例手术）接受了临床长期随访。干预时的中位年龄为10.9岁。90%（423/ 470）的ERCP是治疗性的，10%的新生儿胆汁淤积症患者是诊断性的。最常见的胆道适应症是胆总管结石;最常见的胰腺适应症是慢性胰腺炎。胆道插管成功率为92%（270/294）;胰腺插管成功率为96%（169/176）;计划治疗手术成功率为92%（388/423）。总并发症发生率为19%（65/340）。最常见的并发症是ERCP术后胰腺炎（PEP），发生率为12%（40/340），败血症发生率为5%（18/340）。在单变量分析中，胰腺支架移除对PEP具有保护作用（比值比[OR] 0.1，95%置信区间[CI] 0.01 - 0.75; P = 0.03），脓毒症与肝移植史相关（OR 7.27，95% CI 1.7 - 31.05; P = 0.01）。ERCP术后出血5例，肠穿孔2例。所有并发症均通过支持性医疗护理进行管理。无手术相关死亡。结论ERCP对儿童胰胆管疾病安全、成功率高。不良事件发生率与既往报告相似。
Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography ( ERCP) procedures in children in French and Belgian centers. Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results 271 children underwent 470 ERCP procedures. Clinical long-term follow- up was available for 72% of our patients (340/470 procedures). The median age at inter- vention was 10.9 years. ERCP was therapeutic in 90% (423/ 470) and diagnostic in cases of neonatal cholestasis in 10% of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92% of cases (270/294); pancreatic cannulation in 96% of cases ( 169/176); and planned therapeutic procedures in 92% of cases ( 388/423). The overall complication rate was 19% (65/340). The most common complication was post- ERCP pancreatitis (PEP) in 12% of cases (40/340) and sepsis in 5% ( 18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95% confidence interval [CI] 0.01 - 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 - 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.