Endoscopic retrograde cholangiopancreatography in infants and children

A single institutional experience with endoscopic retrograde cholangiopancr eatography (ERCP) in pediatric patients was reviewed, focusing on the metho d of anesthesia, choice of an endoscope, indications, and complications. Th e medical records of 50 ERCPs performed in 42 infants and children (14 male and 28 female) were reviewed retrospectively. The patients' ages ranged fr om 57 days to 15 years. Forty-four ERCPs were diagnostic and 6 were therape utic, including incision of choledochocele, and sphincterotomy and extracti on of pancreatic stones. All procedures were successful. The most common in dication for ERCP was to evaluate congenital biliary dilatation, in 28 pati ents (67%). Mild cholangitis occurred as a complication in 1 patient, but w as alleviated with medication. A, conventional duodenoscope could be used i n patients older than 10 years. A pediatric duodenoscope was always used in patients under 1 year of age. Either type was chosen individually for thos e aged 1 to 10 years depending on the purpose, diagnostic or therapeutic. I t is noteworthy that ERCP and/or sphincterotomy in a 1-year-old infant and two 2-year-old children were safely performed with the conventional endosco pe. General anesthesia was employed in those younger than 9 years and intra venous sedation and local anesthesia in those older than 11 years. For chil dren aged 9 to 11 years, anesthesia was chosen individually. We concluded t hat ERCP is a relatively easy and safe technique even for infants and child ren when performed by skilled hands with an appropriate duodenoscope under suitable anesthesia. The minimum age for use of the conventional duodenosco pe may be 1 year.