Abstract

BACKGROUND: Endoscopic Retrograde Cholangiopancreatoscopy (ERCP) is increasingly utilized for management of biliary disorders in children and adolescents. Practice patterns surrounding cholangioscopy in pediatric patients, however, are largely uncharacterized.METHODS: We retrospectively analyzed all ERCPs in which cholangioscopy was performed on patients 18 and under at our tertiary care children's hospital from 2015-2020 using our institution's paper and electronic medical record system. Patient demographics, procedure indications, interventions and associated adverse events were analyzed.RESULTS: Over the study period, 307 ERCPs were performed on 282 patients at our children's hospital. Cholangioscopy was performed in 36 procedures (11.7%) using the SpyGlass cholangioscope (Boston Scientific). Antibiotics to cover biliary organisms were administered to all patients pre-cholangioscopy. Mean patient age was 13.6 years (range 7 years - 18 years). The two most common indications for cholangioscopy included electrohydraulic lithotripsy for biliary stone disease and evaluation of biliary stricture (with incidental finding of biliary web in two patients and retained suture material in two patients). Adverse events were less prevalent in patients who underwent cholangioscopy relative to those who underwent ERCP. 0/36, (0%) developed post-ERCP pancreatitis, one patient had self-limited melena (possible self-limited post-sphincterotomy bleeding). Patient care was enhanced by cholangioscopy in 30/36 (83.3%) of these patients.CONCLUSIONS: These data attest to the safety and clinical utility of cholangioscopy in children and adolescents. Cholangioscopy was performed in just over 11% of pediatric patients who underwent ERCP at our academic medical center-rates similar to those reported in adult patients. The radiation-sparing nature of cholangioscopy, coupled with these data supporting its safety, make it particularly appealing for use in children. Further multi-institution evaluation of the utility, safety and range of indications for cholangioscopy in other practice settings would be of great interest and help guide endoscopic care.

View details for DOI 10.1097/MPG.0000000000003499

View details for PubMedID 35653429