Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography in Children: A Large Series Report *Chi-Liang Cheng, *Evan L. Fogel, *Stuart Sherman, *Lee McHenry, *James L. Watkins, †Joseph M. Croffie, †Sandeep K. Gupta, †Joseph F. Fitzgerald, *Laura Lazzell-Pannell, *Suzette Schmidt, and *Glen A. Lehman *Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, and †Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana ABSTRACT Objectives: Our goal is to evaluate the indications, findings, therapies, safety, and technical success of endoscopic retro- grade cholangiopancreatography (ERCP) in children. Methods: Our database was searched for patients 17 years of age or younger undergoing ERCP between January 1994 and March 2003. Additional information was obtained by chart review. The safety and technical success of ERCP were examined. Complications were classified by the consensus criteria. Results: A total of 245 patients (95 M, 150 F; mean age 12.3 years) underwent 329 examinations. Indications included biliary pathology (n = 93), pancreatic pathology (n = 111), and chronic abdominal pain of suspected biliary or pancreatic origin (n = 41). The ERCP findings were bile duct stone(s) (n = 29), benign biliary stricture (n = 19), primary sclerosing cholangitis (n = 7), anomalous pancreaticobiliary union (n = 8), choledochal cyst (n = 5), bile duct leak (n = 6), malignant biliary stricture (n = 2), biliary atresia (n = 1), chronic pancreatitis (n = 44), pancreas divisum (n = 26), pancreatic duct stricture with (n = 6) or without (n = 9) leak, pancreatic tumor (n = 1), periampullary adenoma (n = 2), and sphincter of Oddi dysfunction (n = 65). Endoscopic therapies were performed in 71% of the procedures and included sphincter- otomy, stone extraction, stricture dilation, endoprosthesis place- ment, snare papillectomy, and cystoduodenostomy. Thirty-two (9.7%) post-ERCP complications occurred and included chol- angitis in 1 patient and pancreatitis in 31. The pancreatitis was graded mild in 24, moderate in 5, and severe in 2. No mortality related to ERCP occurred. Conclusions: Diagnostic and therapeutic ERCP results are similar in children and adults except for a lower incidence of malignant disease in children. Technical success rates are high. However, ERCP-related pancreatitis is not uncommon, and the risk and benefits should be carefully reviewed before proceeding. Outcome data are necessary and is currently being accumulated at our institution. JPGN 41:445–453, 2005. Key Words: Pediatrics—ERCP—Endoscopy—Pancreatitis Pancreaticobiliary disease. Ó 2005 Lippincott Williams & Wilkins INTRODUCTION The diagnostic and therapeutic utility of endoscopic retrograde cholangiopancreatography (ERCP) has been well demonstrated in pancreaticobiliary diseases of adults. In contrast, early studies of ERCP in the pediatric population were limited to older children because of the size of the conventional duodenoscope and the absence of validated indications (1). Since the introduction of the pediatric duodenoscope in 1983, its use in younger children, infants, and neonates has increased (2). Earlier reports addressed mainly the feasibility and safety of diagnostic ERCP in children (3). More recent reports have emphasized the therapeutic applications such as sphincterotomy, stent placement, stricture dilation, and stone extraction (4–8). To date, reports of ERCP in pediatric patients remain relatively limited, and most studies are limited to small numbers of patients. The aim of this study was to determine the safety and technical success of ERCP in a large number of pediatric patients. MATERIALS AND METHODS Patients A computer database was searched for data on all patients 17 years of age and younger at the time of ERCP from January 1994 to March 2003. This database prospectively recorded the indications, findings, therapies, and complications of all patients undergoing ERCP since 1994. Also, medical records were retrospectively examined. The Institutional Review Board Received April 29, 2004; accepted June 27, 2005. Address correspondence and reprint requests to Dr. Stuart Sherman, Professor of Medicine and Radiology, Indiana University Medical Center, 550 N. University Blvd, Suite 4100 Indianapolis, IN 46202. (e-mail: ssherman@iupui.edu). Journal of Pediatric Gastroenterology and Nutrition 41:445–453 Ó October 2005 Lippincott Williams & Wilkins, Philadelphia 445