目的:本回顾性分析的目的是通过检查在一个中心发生超过10年的ERCP相关不良事件(AE)来评估内镜逆行胰胆管造影术(ERCP)在儿科患者中的可行性和安全性。
方法:2013年1月至2023年11月在河北医科大学第二医院行ERCP的18岁以下儿科患者。ERCP相关AE根据ERCP相关不良事件定义:欧洲胃肠内镜学会(ESGE)指南。从电子病历中获得经历ERCP相关AE的患者的临床数据用于分析。
结果:在过去的十年中,共有76名儿科患者接受了113例ERCP手术,包括26例重复进行ERCP的患者,共63个程序。有32名男性和44名女性,年龄中位数为13岁(范围为3岁零5个月-17岁零9个月)。在所有ERCP程序中,14(12.4%)是诊断性的,99(87.6%)是治疗性的,成功率100%。16例(14.2%)ERCP相关不良事件,所有ERCP术后胰腺炎(PEP),被观察到,虽然没有其他由ESGE定义的AE,如出血,穿孔,胆管炎,胆囊炎,或观察到镇静相关事件.此外,23例(20.4%)未纳入ESGE定义的ERCP相关AE,其中ERCP后腹痛20例(17.7%),ERCP术后恶心呕吐2例(1.8%),1例(0.9%)计划外再手术。在26例重复行ERCP的儿科患者中,我们观察到15例(57.7%)在初次ERCP期间发生了AE,远高于整体平均水平。
结论:ERCP后腹痛和PEP是儿科患者中最常见的ERCP相关不良事件,而出血和穿孔等严重不良事件很少见。在接受重复ERCP的儿科患者中,初次ERCP后AE的发生率高于总体平均水平。根据我们中心的经验,我们相信ERCP可以安全地应用于3岁以上的胆胰疾病患儿,并获得可靠的临床获益.然而,ERCP相关AE的积极监测和管理对于改善儿科ERCP的临床结局至关重要.
OBJECTIVE: This retrospective analysis aimed to assess the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients by examining ERCP-related adverse events (AEs) occurring over a decade at a single center.
METHODS: Pediatric patients under 18 years old who underwent ERCP at the Second Hospital of Hebei Medical University from 1/2013 to 11/2023 were included. ERCP-related AEs were defined according to ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Clinical data of patients experiencing ERCP-related AEs were obtained from electronic medical records for analysis.
RESULTS: Over the past decade, a total of 76 pediatric patients underwent 113 ERCP procedures, including 26 patients who underwent repeat ERCP, totaling 63 procedures. There were 32 males and 44 females, with a median age of 13 years (range 3 years and 5 months-17 years and 9 months). Among all ERCP procedures, 14 (12.4%) were diagnostic and 99 (87.6%) were therapeutic, with a 100% success rate. 16 cases (14.2%) of ERCP-related AEs, all post-ERCP pancreatitis (PEP), were observed, while no other AEs defined by ESGE such as bleeding, perforation, cholangitis, cholecystitis, or sedation-related events were noted. Additionally, 23 cases (20.4%) of ERCP-related AEs not included in the ESGE definition were observed, including post-ERCP abdominal pain in 20 cases (17.7%), post-ERCP nausea and vomiting in 2 cases (1.8%), and unplanned reoperation in 1 case (0.9%). In the 26 cases of pediatric patients who underwent repeat ERCP, we observed that AEs occurred in 15 cases (57.7%) during their initial ERCP, which was much higher than the overall average level.
CONCLUSIONS: Post-ERCP abdominal pain and PEP are the most common ERCP-related AEs in pediatric patients, while severe AEs such as bleeding and perforation are rare. The incidence of AEs after initial ERCP in pediatric patients who received repeat ERCP is higher than the overall average level. Based on our center\'s experience, we believe that ERCP can be safely performed in children over 3 years old with
biliary and pancreatic diseases and obtain reliable clinical benefits. However, active monitoring and management of ERCP-related AEs are essential to improve the clinical outcomes of pediatric ERCP.