Endoscopic Retrograde Cholangiopancreatography in Children: Feasibility, Success, and Safety with Standard Adult Endoscopes and Accessories

Analysis of the efficacy and safety of endoscopic retrograde cholangiopancreatography for the treatment of pediatric pancreatobiliary diseases

BACKGROUND

Traditional surgical procedures are highly invasive and risky for children with pancreatic and biliary diseases. Endoscopic retrograde cholangiopancreatography (ERCP) has been used mostly in adults because it is a safe and effective surgical procedure. Its application in children will contribute to the treatment and prognosis of children with pancreatic and biliary diseases.

AIM

To analyze the efficacy and safety of ERCP for the treatment of pediatric pancreatobiliary diseases.

METHODS

A retrospective study was performed using the medical records of 101 pediatric patients who received treatment for pancreatobiliary diseases at Children's Hospital Capital Institute of Pediatrics from April 2022 to April 2024. The patients were divided into an observation group (n = 52, treated with ERCP) and a control group (n = 49, treated with traditional surgical methods). Diagnostic and therapeutic outcomes of ERCP were statistically analyzed. Treatment efficacy, time to resume eating, and hospital stay duration were compared between the two groups. Indicators of liver function were monitored preoperatively and one week postoperatively. Dynamic changes in C-reactive protein (CRP) and serum amylase levels were assessed preoperatively and at 6 and 24 hours postoperatively. Postoperative complications were also compared. Logistic multivariate regression was used to analyze the independent effect of ERCP on outcomes.

RESULTS

For the observation group, 36 and 16 patients were diagnosed with biliary and pancreatic diseases, respectively. Compared with the control group, the observation group exhibited a higher overall effective rate (P < 0.05), shorter times to resume eating, shorter hospital stays (P < 0.05), and significantly improved postoperative liver function (P < 0.05). CRP and serum amylase levels were significantly increased in both groups at 6 and 24 hours postoperatively (P < 0.05), but were significantly lower in the observation group (P < 0.05). The observation group also had a lower incidence of complications (P < 0.05). ERCP was an independent factor affecting treatment efficacy, length of hospital stay, total bilirubin, aspartate aminotransferase, and alanine aminotransferase, CRP, serum amylase, and the occurrence of complications in children with pancreaticobiliary diseases (P < 0.05).

CONCLUSION

ERCP effectively enhances the treatment efficacy of pediatric pancreatobiliary diseases, with a reduced inflammatory response, faster postoperative recovery, and fewer complications. ERCP is a safe and effective diagnostic and therapeutic method for pediatric pancreatobiliary diseases.

[Risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography in children]

OBJECTIVES

To investigate the application of endoscopic retrograde cholangiopancreatography (ERCP) in children and the risk factors for post-ERCP pancreatitis (PEP).

METHODS

A retrospective analysis was conducted on the clinical data of 66 children, aged ≤16 years, who underwent ERCP for pancreaticobiliary diseases at the Gastrointestinal Endoscopy Center of the Second Affiliated Hospital of Kunming Medical University from September 2013 to September 2023. The incidence rate of PEP and the risk factors for the development of PEP were analyzed.

RESULTS

A total of 78 ERCP procedures were performed on 66 children, with 5 diagnostic ERCPs, 69 therapeutic ERCPs, and 4 failed procedures. The success rate of ERCP operations was 95% (74/78). There were 17 cases of PEP in total, with an incidence rate of 22%. In the PEP group, the proportion of children with normal preoperative bilirubin and the proportion of guidewire insertion into the pancreatic duct during surgery were higher than in the non-PEP group (P<0.05). The multivariate logistic regression analysis showed that guidewire insertion into the pancreatic duct was an independent risk factor for PEP (P<0.05).

CONCLUSIONS

With the increasing application of ERCP in children with pancreaticobiliary diseases, it is important to select an appropriate intubation technique during surgery to avoid blindly entering the guidewire into the pancreatic duct and reduce the occurrence of PEP.

Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience

Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.

A multifaceted comparative analysis of image and video technologies in gastrointestinal endoscope and their clinical applications

This paper presents a comprehensive exploration of endoscopic technologies in clinical applications across seven tables, each focusing on a unique facet of the medical field. The discourse begins with a detailed analysis of pediatric endoscopes, highlighting their diagnostic capabilities in various conditions. It then delves into the specifications and applications of globally recognized capsule endoscopy devices. Additionally, the paper incorporates an analysis of advanced imaging techniques, such as Narrow Band Imaging (NBI), Flexible Spectral Imaging Color Enhancement (FICE), and i-scan, which are increasingly being integrated into ultrathin gastrointestinal (GI) endoscopes. Factors like technological capabilities, light source, camera technology, and computational constraints are evaluated to understand their compatibility with these advanced imaging techniques, each offering unique advantages and challenges in clinical settings. NBI, for instance, is lauded for its user-friendly, real-time enhanced imaging capabilities, making it effective for early detection of conditions like colorectal cancer and Barrett's esophagus. Conversely, FICE and i-scan offer high customizability and are compatible with a broader range of endoscope models. The paper further delves into innovative advances in movement control for Nasojejunal (NJ) feeding tube endoscopy, elucidating the potential of AI and other novel strategies. A review of the technologies and methodologies enhancing endoscopic procedure control and diagnostic precision follows, emphasizing image and video technologies in pediatric endoscopy, capsule endoscopes, ultrathin endoscopes, and their clinical applications. Finally, a comparative analysis of leading real-time video monitoring endoscopes in clinical practices underscores the continuous advancements in the field of endoscopy, ensuring improved diagnostics and precision in surgical procedures. Collectively, the comparative analysis presented in this paper highlights the remarkable diversity and continuous evolution of endoscopic technologies, underlining their crucial role in diagnosing and treating an array of medical conditions, thereby fostering advancements in patient care and clinical outcomes.