Complications of Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients; A Systematic Literature Review and Meta-Analysis

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• 作者：Danielle Usatin ; MD¹ ; Melissa Fernandes ; MD¹ ; Isabel E. Allen ; PhD² ; Emily R. Perito ; MD¹ ; ² ; James Ostroff ; MD³ ; Melvin B. Heyman ; MD¹ ; ^{mel.heyman@ucsf.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ERCP ; children ; pancreas ; hepatobiliary ; neonatal cholestasis ; endoscopist ; safety
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：179
• 期：Complete
• 页码：160-165.e3
• 全文大小：515 K

文摘

To systematically review risks and summarize reported complication rates associated with the performance of endoscopic retrograde cholangiopancreatography (ERCP) in children during the past 2 decades.

Study design

A systematic literature search of MEDLINE, Embase, and Web of Science from January 1995 to January 2016 was conducted for observational studies published in English. Studies reporting ERCP complications in patients <21 years without history of liver transplant or cholecystectomy were included. A summary estimate of the proportion of children who experienced complications following ERCP was derived via a random effects meta-analysis.

Results

Thirty-two studies involving 2612 children and 3566 procedures were included. Subjects' ages ranged from 3 days to 21 years. Procedures were performed for biliary (54%), pancreatic (38%), and other (8%) indications; 56% of ERCPs were interventional. The pooled complication rate was 6% (95% CI 4%- 8%). Procedural complications included post-ERCP pancreatitis (166, 4.7%), bleeding (22, 0.6%), and infections (27, 0.8%). The pooled estimate of post-ERCP pancreatitis was 3% (95% CI 0.02-0.05), and other complications were 1% (95% CI 0.02-0.05). In the subgroup with neonatal cholestasis, the pooled complication rate was 3% (95% CI 0.01-0.07). Adult and pediatric gastroenterologists and surgeons performed the ERCPs. Available data limited the ability to report differences between pediatric-trained and other endoscopists.

Conclusions

Complications associated with pediatric ERCP range widely in severity and are reported inconsistently. Our review suggests 6% of pediatric ERCPs have complications. Further studies that use systematic and standardized methodologies are needed to determine the frequency and risk factors for ERCP-related complications.