DIAGNOSTIC AND THERAPEUTIC VALUE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN PAEDIATRIC PATIENTS: A SEVEN-YEAR EXPERIENCE AT A TERTIARY CARE HOSPITAL

Authors

  • Shahzad Riyaz Shifa International Hospital, Islamabad
  • Umair Ahmed Narejo Shifa International Hospital, Islamabad
  • Anila Riyaz Pathology Department, Ayub Medical College, Abbottabad-Pakistan
  • Faisal Ali Gastroenterology department Shifa International Hospital, Islamabad

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for the management of pancreaticobiliary disorders in adults, but data on its use in paediatric patients, particularly from low- and middle-income countries, remain limited. This study aimed to evaluate the indications, diagnostic and therapeutic outcomes, and safety of ERCP in children aged 8–17 years at a tertiary care hospital in Pakistan. Methods: A retrospective single-centre review of all paediatric ERCPs performed at a tertiary-level private hospital between February 2013 and August 2019 was conducted. Children aged 17 years or younger who underwent ERCP during this period were identified from the endoscopy software database; the youngest enrolled patient was 8 years of age. Demographic, clinical, procedural, and outcome variables were extracted onto a structured proforma and analysed using SPSS version 21. Descriptive statistics were applied; continuous variables were reported as mean±standard deviation and categorical variables as frequencies and percentages. Results: Forty-five patients aged 8–17 years (mean 15.11±2.42±2.42 years) were enrolled. Of these, 30 (66.7%) were male, and 15 (33.3%) were female. The most common indications were cholestatic liver function tests, followed by pancreatic and common bile duct stones. All procedures were performed under monitored anaesthesia care using midazolam, nalbuphine and propofol; a qualified anaesthetist observed patients throughout and during recovery. Cannulation was successful in 44 of 45 patients (97.8%), and the intended therapeutic procedures, including sphincterotomy and stent placement, were achieved in all cannulated patients. No patient developed post-ERCP pancreatitis, clinically significant bleeding, perforation, cholangitis, or any cardiopulmonary event. Two minor non-procedural adverse events were observed: a skin rash attributed to the pre-procedure antibiotic and self-limiting epistaxis. Conclusion: In this retrospective single-centre study, ERCP performed by experienced adult gastroenterologists using an adult duodenoscope under monitored anaesthesia care appeared to be a safe and effective option for selected children aged 8–17 years with pancreaticobiliary disorders. As the cohort consisted predominantly of adolescents and the study was retrospective with a relatively small sample, larger prospective multicentre studies including younger children are required before these findings can be generalised.

References

1. Keil R, Drábek J, Lochmannová J, Šťovíček J, Koptová P, Wasserbauer M, Frýbová B, et al. ERCP in infants, children, and adolescents—different roles of the methods in different age groups. PLoS One 2019;14(1):e0210805.

2. Dahale AS, Puri AS, Sachdeva S, Srivastava S, Kumar A. Endoscopic retrograde cholangiopancreaticography in children: a single-center experience from Northern India. Indian Pediatr 2019;56:196–8.

3. Limketkai BN, Chandrasekhara V, Kalloo AN, Okolo PI. Comparison of performance and safety of endoscopic retrograde cholangiopancreatography across pediatric age groups. Dig Dis Sci 2013;58:2653–60.

4. Cheng CL, Fogel EL, Sherman S, McHenry L, Watkins JL, Croffie JM, et al. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report. J Pediatr Gastroenterol Nutr 2005;41(4):445–53.

5. Rabenstein T, Schneider HT, Nicklas M, Ruppert T, Katalinic A, Hahn EG, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointest Endosc 1999;50(5):628–36.

6. Yıldırım AE, Altun R, Ocal S, Kormaz M, Ozcay F, Selcuk H. The safety and efficacy of ERCP in the pediatric population with standard scopes: Does size really matter?. Springerplus 2016;5(1):2072.

7. Barth BA, Banerjee S, Bhat YM, Desilets DJ, Gottlieb KT, Maple JT, et al. Equipment for pediatric endoscopy. Gastrointest Endosc 2012;76(1):8–17.

8. Teng R, Yokohata K, Utsunomiya N, Takahata S, Nabae T, Tanaka M. Endoscopic retrograde cholangiopancreatography in infants and children. J Gastroenterol 2000;35:39–42.

9. Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group. Pediatr Surg Int 2007;23:111–6.

10. Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children. World J Gastroenterol 2010;16(4):490–5.

11. Otto AK, Neal MD, Slivka AN, Kane TD. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases. Surg Endosc 2011;25:2536–40.

12. Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr 2001;32(1):26–33.

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Published

2026-08-24

How to Cite

1.
Riyaz S, Umair Ahmed Narejo, Anila Riyaz, Faisal Ali. DIAGNOSTIC AND THERAPEUTIC VALUE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN PAEDIATRIC PATIENTS: A SEVEN-YEAR EXPERIENCE AT A TERTIARY CARE HOSPITAL. J Ayub Med Coll Abbottabad [Internet]. 2026 Aug. 24 [cited 2026 Sep. 9];38(1):1-5. Available from: https://www.jamc.ayubmed.edu.pk/index.php/jamc/article/view/13176

Issue

Vol. 38 No. 1 (2026): Journal of Ayub Medical College Abbottabad

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ORIGINAL ARTICLE

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