1
|
Ahmed S, Shahriar A, Rahman N, Alam MZ, Nurnabi M. Synthesis of gamma irradiated acrylic acid-grafted-sawdust (SD-g-AAc) for trivalent chromium adsorption from aqueous solution. JOURNAL OF HAZARDOUS MATERIALS ADVANCES 2024; 14:None. [PMID: 38933367 PMCID: PMC11200213 DOI: 10.1016/j.hazadv.2024.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 06/28/2024]
Abstract
Water pollution caused by chromium released from tannery is a serious concern to the environment and public health. Chromium removal from tannery effluent is a crying need before discharging to the surface water. In this study, acrylic acid-grafted sawdust was prepared by Tectona grandis sawdust grafting with acrylic acid employing gamma irradiation in the presence of air and Mohr's salt. It was treated with NaOH and the characterization of surface morphology and functional groups of modified sawdust was studied by SEM and FTIR.. The effects of solution pH, adsorbent dosage, adsorption time, and initial Cr(III) ion concentration were investigated by batch sorption studies. The process was found to be pH, temperature and concentration dependent. Langmuir and Freundlich isotherms were applied to realize the adsorption process in depth, and it was found that the Langmuir isotherm model fitted well with experimental data (R2 value of 0.983). The maximum monolayer adsorption capacity of acrylic acid-grafted sawdust for Cr(III) from aquous solution was found to be 21.55 mg g-1 at 25 °C. Pseudo-first-order and pseudo-second-order kinetic models were employed to analyze the kinetics of the process, and it was found that the experimental process followed the pseudo-second-order kinetic model, i.e. chemisorption. This study revealed that acrylic acid-grafted sawdust has a decent potential for the removal of Cr(III) from tannery effluents.
Collapse
Affiliation(s)
- Sobur Ahmed
- Institute of Leather Engineering and Technology, University of Dhaka, 44-50, Hazaribagh, Dhaka, 1209, Bangladesh
| | - Abrar Shahriar
- Institute of Leather Engineering and Technology, University of Dhaka, 44-50, Hazaribagh, Dhaka, 1209, Bangladesh
| | - Nazia Rahman
- Institute of Nuclear Science and Technology, Bangladesh Atomic Energy Commission, Dhaka, 3787, Bangladesh
| | - Md. Zahangir Alam
- Department of Applied Chemistry and Chemical Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Mohammad Nurnabi
- Department of Applied Chemistry and Chemical Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| |
Collapse
|
2
|
Zhang T, Shu Y, Weng H, Weng M, Zhou Y, Cai W, Wang X. A therapeutic ERCP in an only 5.9 kg infant with obstruction jaundice using JF-260V duodenoscope. BMC Pediatr 2024; 24:281. [PMID: 38678261 PMCID: PMC11055377 DOI: 10.1186/s12887-024-04765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) has found extensive use in pediatric patients; however, challenges persist in the application of therapeutic ERCP in infants. CASE PRESENTATION This case report details the presentation of a 5.9-kilogram infant with obstructive jaundice and suspected hemolytic anemia who underwent ERCP to alleviate biliary obstruction. The infant was admitted due to clay-colored stools, jaundice, and liver injury. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed dilation of the common bile duct (CBD) accompanied by the presence of stones. ERCP was conducted using a JF-260V duodenoscope under general anesthesia. Successful stone extraction and biliary drainage were achieved. CONCLUSIONS In centers with considerable expertise in ERCP and pediatric anesthesia, the use of a conventional adult duodenoscope for therapeutic ERCP in infants can be considered safe and feasible, provided careful and stringent patient selection criteria are applied. In the future, clear guidelines and standardized protocols for the indications and procedures of pediatric ERCP should be established.
Collapse
Affiliation(s)
- Tian Zhang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Yijun Shu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Hao Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Mingzhe Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Ying Zhou
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Wei Cai
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Xuefeng Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China.
| |
Collapse
|
3
|
Saraiva RO, Borges VP, Silva MJ, Loureiro R, Capela T, Ramos G, Canena J, Mateus Dias A, Alves R, Coimbra J. Endoscopic Retrograde Cholangiopancreatography on Pediatric Patients: Experience of a Portuguese Adult Gastroenterology Department. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:110-115. [PMID: 38633821 PMCID: PMC11021817 DOI: 10.1159/000529090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 04/19/2024]
Abstract
Introduction Experience with endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population is limited. Few medical centers have experts specifically trained in pediatric therapeutic endoscopy. As a result, patients are generally referred to adult endoscopists with high experience in the procedure. The aim of this study was to characterize the experience of an adult endoscopy unit with ERCP on pediatric patients, with a special focus on very young patients. Methods We retrospectively analyzed indications, technical success rate, final clinical diagnosis, and complications of ERCPs in children <18 years at our tertiary referral hospital center between January 1994 and June 2022. Results Sixty-five ERCPs were performed on 57 children with a median age of 13 years (range 1-17 years). Eleven ERCPs were performed on 9 patients up to 5 years old. Indications for ERCP were as follows: biliary obstruction (n = 40), mainly due to choledocholithiasis, lithiasic acute pancreatitis (n = 19), recurrent pancreatitis (n = 3), stent extraction (n = 2), and post-operative biliary fistula (n = 1). The cannulation success rate was 95.1%. Therapeutic interventions were performed in 79% of ERCP. All patients were followed up as inpatients. Complications were recorded in two procedures (3.1%), and no procedure-related mortality occurred. Conclusion In our experience, ERCP in children can be safely performed with high success rates by advanced adult-trained expert endoscopists at a high-volume center.
Collapse
Affiliation(s)
- Rita Ornelas Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Verónica Pavão Borges
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Mário Jorge Silva
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Rafaela Loureiro
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Tiago Capela
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Gonçalo Ramos
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Jorge Canena
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| | - António Mateus Dias
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - Rui Alves
- Department of Pediatric Surgery, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
| | - João Coimbra
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisbon, Portugal
- NOVA Medical School − Faculdade de Ciências Médicas, Lisbon, Portugal
| |
Collapse
|
4
|
Garg L, Vaidya A, Kale A, Gopan A, Ansari A, Patra BR, Shukla A. Safety and efficacy of endoscopic retrograde cholangiopancreatography in pediatric pancreatic and biliary disorders. Indian J Gastroenterol 2024:10.1007/s12664-023-01498-7. [PMID: 38367160 DOI: 10.1007/s12664-023-01498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/01/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION There is sparse data from India on indications, technical success, safety and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) using standard adult duodenoscope in the pediatric population. METHODS Retrospective analysis of prospectively maintained electronic endoscopy and clinical database was performed to identify pediatric patients (age ≤ 18 years) who underwent ERCP between January 2017 and December 2022. Demographics and procedural details including indications, cholangio-pancreatogram findings, endotherapy type performed, technical and clinical success and complications were noted. RESULTS As many as 150 pediatric patients were included of whom 88 had pancreatic (mean age-13.7 years) and 62 had biliary disease (mean age- 14.9 years). Common pancreatic ERCP indications were chronic pancreatitis (n = 45 [51.1%]), pancreatic duct disruption fistula (n = 21 [23.9%]) and recurrent acute pancreatitis (n = 16 [18.2%]). Among biliary indications were choledocholithiasis (n = 29 [46.8%]), benign bile duct strictures (n = 13 [21%]), bile duct injury/leak and biliary stent removal (n = 7 [11.3%]) , choledochal cyst (n = 5 [8.1%]) and pancreatic mass causing biliary compression (n = 1 [1.6%]). Technical success in pancreatic and biliary ERCP was 94.3% and 95.2%, respectively, and clinical success was 84.1% and 93.5%, respectively. Most common complications following pancreatic ERCPs were acute pancreatitis (n = 9 [10.2%]) (mild = 5, moderate = 4) patients and post sphincterotomy bleed in one (1.1%). Among biliary ERCPs, post ERCP pancreatitis was seen in (n = 3 [4.8%]) (mild = 2, moderate = 1). CONCLUSION ERCP can be safely and effectively performed in children using standard duodenoscope. Chronic pancreatitis, choledocholithiasis and pancreatic divisum are common pediatric ERCP indications.
Collapse
Affiliation(s)
- Love Garg
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Arun Vaidya
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Amrit Gopan
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Abu Ansari
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Biswa Ranjan Patra
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India.
| |
Collapse
|
5
|
Hosseini A, Sohouli MH, Sharifi E, Sayyari A, Sridharan K, Tajalli S, Imanzadeh N, Fatahi S. Indications, success, and adverse event rates of pediatric endoscopic retrograde cholangiopancreatography (ERCP): a systematic review and meta-analysis. BMC Pediatr 2023; 23:596. [PMID: 37996785 PMCID: PMC10668434 DOI: 10.1186/s12887-023-04392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND To improve knowledge on endoscopic retrograde cholangiopancreatography (ERCP) in children, we aimed to study the proportion of indications, success rate and complication of ERCP. METHODS We performed a systematic search of all articles published up to December 2022 in the following databases: Cochrane Library, PubMed (MEDLINE) and Scopus. The meta-analysis was performed using a random-effects model. Heterogeneity was determined by the I2 statistics and the Cochrane Q test. The included data were analyzed to identify the proportion of indications, success rate and complications of ERCP in children. RESULTS Based on data from 52 studies with a total of 5624 participants, the most common indications for ERCP in children were biliary [48% (95% CI: 0.40 - 0.57; I2 = 98.17%, P < 0.001)] and both biliary and pancreatic [41% (95% CI: 0.33 - 0.49; I2 = 98.27%, P < 0.001)]. The success rate of ERCP was 95% (95% CI: 0.94 - 0.96; I2 = 82.53%, P < 0.001) with the overall complication rate of 7% (95% CI: 0.05 - 0.09; I2 = 82.06%, P < 0.001). The pooled estimate for the incidence of post ERCP pancreatitis was 4% (95% CI: 0.03 - 0.06; I2 = 85.46%, P < 0.001) and the bleeding was 0% (95% CI: 0.0 - 0.0; I2 = 28.21%, P = 0.03). CONCLUSIONS ERCP appears to be performed safely in children with a similar success rate as in the adult population.
Collapse
Affiliation(s)
- Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Sharifi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Sayyari
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Saleheh Tajalli
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Imanzadeh
- School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Trocchia C, Khalaf R, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Werlin SL, Dua K, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Pediatric ERCP in the Setting of Acute Pancreatitis: A Secondary Analysis of an International Multicenter Cohort Study. J Pediatr Gastroenterol Nutr 2023; 76:817-821. [PMID: 36913706 PMCID: PMC10198832 DOI: 10.1097/mpg.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.
Collapse
Affiliation(s)
| | - Racha Khalaf
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Ernest Amankwah
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Wenly Ruan
- Baylor College of Medicine; Texas Children's Hospital, Houston, TX
| | | | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, The Republic of Korea
| | - Mercedes Martinez
- Columbia University; New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- Zucker School of Medicine at Hofstra/Northwell; Cohen Children's Medical Center, Lake Success, NY
| | - Steven L Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Victor L Fox
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Michael Wilsey
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
| |
Collapse
|
7
|
Grover AS, Gugig R, Barakat MT. Endoscopy and Pediatric Pancreatitis. Gastrointest Endosc Clin N Am 2023; 33:363-378. [PMID: 36948751 DOI: 10.1016/j.giec.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Children and adolescents are increasingly impacted by pancreatic disease. Interventional endoscopic procedures, including endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography, are integral to the diagnosis and management of many pancreatic diseases in the adult population. In the past decade, pediatric interventional endoscopic procedures have become more widely available, with invasive surgical procedures now being replaced by safer and less disruptive endoscopic interventions.
Collapse
Affiliation(s)
- Amit S Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA
| | - Monique T Barakat
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA; Division of Gastroenterology, Stanford University Medical Center, Stanford, CA 94305, USA.
| |
Collapse
|
8
|
Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative. J Pediatr Gastroenterol Nutr 2022; 75:755-760. [PMID: 36122368 DOI: 10.1097/mpg.0000000000003612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs. METHODS In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events. RESULTS A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified. CONCLUSIONS This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.
Collapse
|
9
|
Lorio E, Moreau C, Michalek JE, Patel S. Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates. Gastroenterology Res 2022; 15:314-324. [PMID: 36660468 PMCID: PMC9822666 DOI: 10.14740/gr1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to aid in risk assessment of pediatric endoscopic retrograde cholangiopancreatography (ERCP) candidates by utilizing a national pediatric database with a large sample to assess how patient characteristics may affect ERCP complication rates. Methods The Kids' Inpatient Database (KID) is a sample of pediatric discharges in states participating in the Healthcare Cost and Utilization Project (HCUP). This database provides demographic information, hospitalization duration, and outcome information for hospitalizations during which an ERCP occurred. International Classification of Diseases (ICD) codes were used to determine the hospitalization indication. ERCP complication rate was ascertained via ICD codes. All statistical analyses were performed using SAS 9.4. Results Complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. This analysis captured a large Hispanic population, specifically in the South and West regions. Gallbladder calculus and cholecystitis were more likely to occur in females. A higher percentage of patients in the age 10 - 17 group were female (72.2% vs. 52.7%, P < 0.01) and Hispanic (33.4% vs. 22.7%, P < 0.01) compared to the age 0 - 9 group. Age 0 - 5 and male gender were associated with lower routine home discharge rates and longer lengths of stay. Complications occurred at a higher rate in ages 0 - 5, though the difference was not statistically significant. Conclusions ERCP is a safe procedure for pediatric patients with low complication rates and rare mortality. We found statistically significant differences in the procedure indications between pediatric age groups, races, and genders. Age ≤ 5 years and male gender were associated with more complicated healthcare courses.
Collapse
Affiliation(s)
- Eric Lorio
- Department of Gastroenterology and Hepatology, Tulane University School of Medicine, New Orleans, LA, USA,Corresponding Author: Eric Lorio, Department of Gastroenterology and Hepatology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
| | - Chris Moreau
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Texas Health San Antonio, TX, USA
| | - Joel Edmund Michalek
- Department of Population Health Sciences, University of Texas Health San Antonio, TX, USA
| | - Sandeep Patel
- Advanced Endoscopy Program, University of Texas Health San Antonio, TX, USA,Department of Gastrointestinal Endoscopy, University Hospital, San Antonio, TX, USA,CHRISTUS Health, San Antonio, TX, USA
| |
Collapse
|
10
|
Perera KDR, Nawarathne NMM, Samarawickrama VT, Deraniyagala MP, Luxman WGE, Fernandopulle ANR. Endoscopic Retrograde Cholangiopancreatography in Children: Feasibility, Success, and Safety with Standard Adult Endoscopes and Accessories. Pediatr Gastroenterol Hepatol Nutr 2022; 25:406-412. [PMID: 36148288 PMCID: PMC9482827 DOI: 10.5223/pghn.2022.25.5.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/02/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary and pancreatic diseases in the pediatric population was not well defined until recently. Our aim was to determine the feasibility, outcomes, and safety of ERCP in a local pediatric population, particularly using standard adult endoscopes and accessories. METHODS This retrospective study was conducted at the National Hospital of Sri Lanka. Pediatric patients (aged <16 years) who underwent ERCP from January 2015 to December 2020 were included in the study. Data, including patient demographics, indications for the procedure, technical details, and associated complications, were collected from the internal database and patient records maintained at the hospital. RESULTS The study included 62 patients who underwent a total of 98 ERCP procedures. All the procedures were performed by adult gastroenterologists using standard adult endoscopes and accessories. The mean age was 11.01±3.47 years. Pancreatic diseases were the major indications for most of the procedures (n=81, 82.7%), with chronic pancreatitis being the most common. Seventeen procedures (17.3%) were carried out for biliary diseases. Overall cannulation and technical success rates were 87.8% and 85.7%, respectively. Stent placement was the most common therapeutic intervention (n=66; 67.4%). Post-ERCP pancreatitis was the most common complication, occurring in eight patients (8.2%). CONCLUSION ERCP can be successfully and safely performed in pediatric populations using standard adult endoscopes and accessories with complications similar to those of adults. Adult ERCP services can be offered to most pediatric patients without additional costs of pediatric endoscopes and accessories.
Collapse
|
11
|
Dişçi E, Peksöz R, Yıldız M, Yıldırgan Mİ, Albayrak Y, Fakirullahoğlu M, Fırıncı B, Atamanalp SS. Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2022; 32:320-324. [PMID: 35041496 DOI: 10.1089/lap.2021.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique used in the diagnosis and treatment of pancreaticobiliary system. ERCP is used less frequently in children than in adults due to the rarity of pancreaticobiliary diseases and technical difficulties. However, ERCP is a safe, effective diagnosis and treatment tool for children. Methods: All patients within the age range of 1-19 years, who underwent ERCP between 2010 and 2021 at our endoscopy unit, were retrospectively examined. Patient demographics, use of imaging methods, indications, type of sedation, interventions, success of ERCP, findings, and complications were evaluated. Results: Overall, 105 ERCPs were performed in 66 children (29 male and 37 female). The indications were choledocholithiasis, cyst hydatic, choledochal cyst, biliary atresia or anomaly, liver transplantation-related disorders, and pancreatic disorders, respectively. ERCP was finished as diagnostic ERCP in 20% and as therapeutic in 80%. Therapeutic procedures were sphincterotomy, stent placement or removal, stone or debris extraction, and balloon sweep or dilatation, respectively. The success rate in the procedures was 75.23%. The overall complication rate was 15.23%. Postprocedure pancreatitis occurred in 11.42%, hemorrhage occurred in 2.85%, and aggravation of cholangitis in 0.95%. All complications were managed conservatively. Conclusion: ERCP in pediatric patients is a safe procedure that can be performed by adult endoscopists with high success rates. Since our region is an endemic region for hydatid cyst disease, the most common ERCP indication after choledocholithiasis is procedures related to liver hydatid cyst disease. The most common complication was pancreatitis, and complications were treated medically.
Collapse
Affiliation(s)
- Esra Dişçi
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | - Rıfat Peksöz
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | - Metin Yıldız
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | | | - Yavuz Albayrak
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | | | - Binali Fırıncı
- Department of Pediatric Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | | |
Collapse
|
12
|
Oh C, Cheun JH, Kim HY. Clinical comparison between the presence and absence of protein plugs in pediatric choledochal cysts: experience in 390 patients over 30 years in a single center. Ann Surg Treat Res 2021; 101:306-313. [PMID: 34796147 PMCID: PMC8564075 DOI: 10.4174/astr.2021.101.5.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/16/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose The incidence of choledochal cyst (CC) with protein plugs is between 15.5%-40.4%. However, studies on CCs with protein plugs in children are limited. We aimed to analyze the clinical features, surgical findings, and complications of pediatric CCs with and without protein plugs. Methods We retrospectively analyzed 390 patients who underwent surgery for CCs between January 1987 and September 2017. The patients were divided into 2 groups: groups A (CC with protein plugs) and B (CC without protein plugs). The presence of protein plugs was evaluated using preoperative images or identified during surgery. Results One hundred forty-two (36.4%) patients had protein plugs in the pancreaticobiliary duct. The most common initial clinical presentation was abdominal pain, and its incidence was significantly higher in group A (66.2%) than in group B (54.8%) (P = 0.032). The incidence of accompanying pancreatitis was also significantly higher in group A (37.3% vs. 27.0%) (P = 0.040). Anomalous pancreaticobiliary ductal union (APBDU) was found in 261 patients (66.9%) and its incidence was significantly higher in group A (74.6% vs. 62.5%) (P = 0.014). Most protein plugs were found in the cyst (88.0%) and common channel (31.7%). The incidence of early complications was higher in group A; conversely, that of late complications did not differ. Conclusion Approximately 36.4% of the pediatric CC patients were accompanied by protein plugs. Abdominal pain, pancreatitis, and APBDU were more commonly observed among those with protein plugs than among those without; long-term complications did not differ between them.
Collapse
Affiliation(s)
- Chaeyoun Oh
- Department of Pediatric Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jong-Ho Cheun
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Tagawa M, Morita A, Imagawa K, Mizokami Y. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children. Dig Endosc 2021; 33:1045-1058. [PMID: 33423305 DOI: 10.1111/den.13928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
Gastrointestinal endoscopy is fundamental to diagnostic and therapeutic procedures in pediatric gastroenterology. In the decades since endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) for hepatobiliary and pancreatic disease were introduced into clinical practice, there has been increasing interest in these procedures, and practice guidelines and position papers that clearly define the role of ERCP and EUS in children have been published. Based on the distinction of endoscopy between children and adults, this review focuses on the current state of ERCP and EUS procedures in children, including the types of endoscopes used in children, general anesthesia and radiation exposure, biliary and pancreatic indications, considerations of education and training for ERCP and EUS procedures in children, and expectations for development of endoscopes for children.
Collapse
Affiliation(s)
- Manabu Tagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Atsushi Morita
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuo Imagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Mizokami
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
| |
Collapse
|
14
|
Stonelake S, Ali S, Pinkey B, Ong E, Anbarasan R, McGuirk S, Perera T, Mirza D, Muiesan P, Sharif K. Fifteen-Year Single-Center Experience of Biliary Complications in Liver Trauma Patients: Changes in the Management of Posttraumatic Bile Leak. Eur J Pediatr Surg 2021; 31:245-251. [PMID: 32422676 DOI: 10.1055/s-0040-1710391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Management of posttraumatic bile leak has evolved over time in our unit, from endoscopic retrograde cholangiopancreatography (ERCP) stenting to intraperitoneal drainage (IPD) alone as first-line treatment for intraperitoneal bile leak. MATERIALS AND METHODS Retrospective review of liver trauma patients from 2002 to 2017. Demographics, time and mode of diagnosis of bile leak, management, and outcome were analyzed of the box plot. RESULTS In 118 patients, there were 28 traumatic bile leaks. Eighteen were free intraperitoneal and 10 were localized bilomas. The median time of diagnosis was 6 days following injury. The modes of diagnosis were preemptive hepatobiliary scintigraphy (18), computed tomography (CT) or ultrasound (7), and laparotomy (3). Free intraperitoneal biliary leak management included 11 IPD alone, 3 IPD plus ERCP, 2 IPD plus transcystic biliary stent (TBS), 1 operative cholangiogram, and 1 no intervention. Median time of IPD duration was 7 days (4-95) in IPD alone versus 14 days (6-40) in IPD + ERCP/TBS (p = 0.3). Median inpatient length of stay was 13 days (8-44) in IPD alone versus 12 days (8-22) in IPD + ERCP/TBS (p = 0.4). CONCLUSION Placement of IPD alone, as first-line treatment, is safe and effective in the management of intraperitoneal bile leaks, avoiding the costs and potential complications of ERCP.
Collapse
Affiliation(s)
- Stephen Stonelake
- Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
| | - Sana Ali
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Benjamin Pinkey
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Evelyn Ong
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Ravindar Anbarasan
- Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
| | - Simon McGuirk
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Thamera Perera
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Darius Mirza
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Paolo Muiesan
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Khalid Sharif
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| |
Collapse
|
15
|
Barakat MT, Cholankeril G, Gugig R, Berquist WE. Nationwide Evolution of Pediatric Endoscopic Retrograde Cholangiopancreatography Indications, Utilization, and Readmissions over Time. J Pediatr 2021; 232:159-165.e1. [PMID: 33197494 DOI: 10.1016/j.jpeds.2020.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyze outcome and utilization trends over time of pediatric endoscopic retrograde cholangiopancreatography (ERCP) in an all-capture US population-level study. STUDY DESIGN Using the National Inpatient Sample (2005-2014) and National Readmission Database (2010-2014), we identified pediatric (age <20 years) hospitalizations during which ERCP was performed and assessed ERCP-associated readmissions. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify hospitalization diagnoses, comorbidities, and patient/hospital characteristics. Multivariate logistic regression analyses were performed to determine significant predictors (P < .05) of 30-day readmission. RESULTS A total of 11 060 hospitalized pediatric patients underwent ERCP between 2005 and 2014. Most were female (n = 8859; 81%), aged 14-20 years (n = 9342; 84%), and white (n = 4230; 45%). Most (85%) of ERCPs were therapeutic, and leading indications were biliary (n = 5350; 48%) and pancreatitis (n = 3218; 29%). Thirteen pecent of patients were readmitted post-ERCP. Odds for 30-day readmission were highest for patients with a history of liver transplantation, age 0-4 years, male sex, and obesity (P < .001 for each). Patients in both urban teaching and urban hospitals had much lower odds than those in rural hospitals for prolonged length of stay associated with ERCP. CONCLUSIONS These data represent a comprehensive study of nationwide trends in age-specific volumes and outcomes following ERCP in the pediatric population and provide important insights into trends in pediatric pancreaticobiliary disease management, as well as practice setting, patient characteristics, and patient comorbidities associated with pediatric post-ERCP outcomes, including readmission and length of stay.
Collapse
Affiliation(s)
- Monique T Barakat
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA
| | - William E Berquist
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA.
| |
Collapse
|
16
|
Standardization of common bile duct size using ultrasound in pediatric patients. J Pediatr Surg 2019; 54:1123-1126. [PMID: 30922684 DOI: 10.1016/j.jpedsurg.2019.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/21/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND/PURPOSE The incidence of choledocholithiasis is increasing. The diagnosis of common bile duct (CBD) obstruction is based on abnormal CBD size. Establishing norms for CBD size in children would improve diagnostic accuracy. We analyzed ultrasounds (US) to determine normal pediatric CBD size based on age and then validated this against patients with choledocholithiasis. METHODS A retrospective review was conducted for children less than 21 years of age with US defined CBD size. Patients were stratified into age groups by ANOVA statistical analysis. Secondary analysis included patients with confirmed choledocholithiasis in comparison to the normal cohort. RESULTS A total of 778 patients had US without pathology. Group 1 (<1 year) had a mean CBD of 1.24±0.54 mm, group 2 (1-10 years) 1.97±0.71 mm, and group 3 (>10 years) 2.98±1.17 mm, p<0.05. Fourteen additional patients were found to have choledocholithiasis with a mean CBD size of 8.1 mm. All patients with choledocholithiasis had CBD sizes outside of our normal range, but only 50% of patients had enlarged CBD size based on adult normal range of values. CONCLUSION Normal CBD size in children is less than a normal adult patient. More accurate normal values will aid in determining if a child needs further evaluation for possible obstruction of the CBD. TYPE OF STUDY diagnostic Level of evidence: III.
Collapse
|
17
|
Öztürk Y, Akarsu M. Pediatric endoscopic retrograde cholangiopancreatography. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:120-121. [PMID: 30843861 DOI: 10.5152/tjg.2019.270219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yeşim Öztürk
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mesut Akarsu
- Department of Gastroenterology and Hepatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| |
Collapse
|
18
|
Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist. World J Gastrointest Endosc 2019; 11:5-21. [PMID: 30705728 PMCID: PMC6354112 DOI: 10.4253/wjge.v11.i1.5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023] Open
Abstract
Despite improvements in endoscopic technologies and accessories, development of advanced endoscopy fellowship programs, and advances in ancillary imaging techniques, biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can still be unsuccessful in up to 20% of patients, even in referral centers. Once cannulation has been deemed to be difficult, the risk of post-ERCP pancreatitis and technical failure inherently increases. A number of factors, including endoscopist experience and patient anatomy, have been associated with difficult biliary cannulation, but predicting a case of difficult cannulation a priori is often not possible. Numerous techniques such as pancreatic guidewire and stenting, early pre-cut, and rendezvous may be employed when standard approaches fail. Data regarding the rate of success and adverse events of these techniques have been variable, though most studies suggest that pancreatic duct stenting generally reduces the rate of post-ERCP pancreatitis in instances of difficult biliary cannulation. Here we provide a review on difficult biliary cannulation and discuss how the choice of which techniques to employ and how to best employ them should be individualized and take into account the skill of the endoscopist, the disorder being treated, the anatomy of the patient, and the available biomedical literature.
Collapse
Affiliation(s)
- Rani Berry
- Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, United States
| | - James Y Han
- Department of Internal Medicine, University of California, Irvine, CA 92868, United States
| | - James H Tabibian
- Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| |
Collapse
|
19
|
In-hospital Pediatric Endoscopic Retrograde Cholangiopancreatography Is Associated With Shorter Hospitalization for Children With Choledocholithiasis. J Pediatr Gastroenterol Nutr 2019; 68:64-67. [PMID: 30044307 DOI: 10.1097/mpg.0000000000002102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists. METHODS Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004). CONCLUSIONS Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.
Collapse
|
20
|
Kohoutova D, Tringali A, Papparella G, Perri V, Boškoski I, Hamanaka J, Costamagna G. Endoscopic treatment of chronic pancreatitis in pediatric population: Long-term efficacy and safety. United European Gastroenterol J 2018; 7:270-277. [PMID: 31080612 DOI: 10.1177/2050640618817699] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022] Open
Abstract
Background Chronic pancreatitis (CP) in children is an inreasingly recognized disease. Objective The purpose of study was to analyse the safety and long-term efficacy of endoscopic treatment in children with CP. Methods Records of 38 patients aged <18 years, referred to the Digestive Endoscopy Unit at Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS between 1991 and 2017, were reviewed. Abdominal pain, analgesia and number of episodes of acute pancreatitis in the pre- and post- endoscopic retrograde cholangiopancreatography (ERCP) period were evaluated. Need for surgery was assessed. Therapeutic intervention data and complications were interrogated. Results In total 158 ERCPs were performed. Median post-ERCP follow-up was 7 years. The majority of patients had CP type IV (47%) and type Ib (37%) (Cremer's classification). Major papilla pancreatic sphincterotomy was performed in 47%, major and minor in 24% and minor in 29% of patients. Stones/plugs were removed in at least one ERCPs in 66% individuals. Eleven out of 38 patients had stricture of the pancreatic duct; these were dilated and stented in 5/11 and stented in 6/11. Five complications were recorded (3%). Severity and frequency of abdominal pain improved significantly; p < 0.001. Use of analgesia and number of episodes of acute pancreatitis decreased significantly; p < 0.001. One child required subsequent surgery. Conclusion Endoscopic management of symptomatic CP in children is safe and effective.
Collapse
Affiliation(s)
- D Kohoutova
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,The Royal Marsden NHS Foundation Trust, London, UK.,Charles University, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic
| | - A Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Papparella
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - V Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - I Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - J Hamanaka
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - G Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia.,Chair of Digestive Endoscopy, IHU-USIAS, University of Strasbourg, Strasbourg, France
| |
Collapse
|
21
|
Rosen JD, Lane RS, Martinez JM, Perez EA, Tashiro J, Wagenaar AE, Van Haren RM, Kumar A, Sola JE. Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 2017; 52:1148-1151. [PMID: 28188033 DOI: 10.1016/j.jpedsurg.2017.01.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Despite its diagnostic and therapeutic utility, endoscopic retrograde cholangiopancreatography (ERCP) is underutilized in children. METHODS Patients younger than 18years undergoing ERCP from 2000 to 2014 at a children's hospital were identified. Patient characteristics and outcomes were evaluated. RESULTS Overall, 215 ERCPs (78% therapeutic) were performed in 184 patients. Our cohort was 67% female, with a median age (IQR) of 14 (8) years. Common indications were choledocholithiasis, pancreatitis, sclerosing cholangitis, and postoperative complication. ERCP was performed with an adult duodenoscope in 96% of cases and with a pediatric duodenoscope in the remainder. Patients requiring a pediatric scope ranged in weight from 4.3 to 22.8kg, with ages from 2months to 6years. Cannulation was successful in 97% of cases. Findings included bile duct (BD) stones, BD dilatation, sclerosing cholangitis, BD stricture, pancreatic duct (PD) disruption, choledochal cyst, pancreas divisum, and BD leak. The most common therapeutic techniques were sphincterotomy, stone extraction, and stent. Complication rate was overall 10% with no deaths. On multivariate analysis, PD cannulation was associated with pancreatitis (OR 3.48), while age<4years (10.7), male gender (12.8), and precut sphincterotomy (31.3) were associated with hemorrhage (all p<0.05). CONCLUSION ERCP can be performed successfully and safely in children with complication rates comparable to those in adults. The type of cannulation and patient age are independent risk factors for complications. LEVEL OF EVIDENCE Treatment study-IV.
Collapse
Affiliation(s)
- Jordan D Rosen
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rebecca S Lane
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jose M Martinez
- Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Robert M Van Haren
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ashwini Kumar
- Division of Laparoendoscopic Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
| |
Collapse
|
22
|
Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol 2016; 30:793-805. [PMID: 27931637 DOI: 10.1016/j.bpg.2016.10.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/11/2016] [Accepted: 10/21/2016] [Indexed: 01/31/2023]
Abstract
Even though considered safe, endoscopic retrograde cholangiopancreatography (ERCP) is among the endoscopic procedures associated with the highest rate of complications. Post ERCP pancreatitis (PEP) is the most common complication of ERCP. Several independent risk factors have been associated with PEP. Prophylactic PD stenting has been shown to be highly effective in preventing PEP. More recent studies have suggested that NSAIDs, especially rectal indomethacin, could by itself be effective in preventing PEP. However, head to head RCTs comparing PD stents with NSAIDs would be required to confirm this. Other complications include ERCP induced bleeding, perforation, and cholangitis. Bleeding is related to morphological, procedural, and patient related factors. Early identification and correction of the risk factors are of paramount importance in preventing bleeding. Risk of infection is particularly high during ERCP. It is important to ensure complete drainage of obstructed biliary system in order to reduce the risk of post-ERCP cholangitis.
Collapse
Affiliation(s)
- Rupjyoti Talukdar
- Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500082, Telangana, India; Asian Healthcare Foundation, 6-3-661 Somajiguda, Hyderabad, 500082, Telangana, India.
| |
Collapse
|