ERCP in the evaluation of abdominal pain in children

Background: ERCP is feasible and safe in the pediatric Population. Its utility in the evaluation of children with pain Suggestive of a pancreatobiliary origin without objective findings compared with those with abnormal biochemical and/or imaging Studies is not well known. Objective: To determine the utility of ERCP in the diagnosis and management of children seen with abdominal pain. Design: Retrospective review Setting: One tertiary center. Patients: All children Who underwent ERCP at one tertiary center from 1994 to 2004. Method: An endoscopy database was used. Data sets with regard to indications, technical Success, complications, and Outcomes were evaluated. Before ERCP children with abdominal pain were categorized into 2 groups: group 1, those with objective findings, namely abnormal biochemistry and/or abnormal imaging studies; group 11, those who had abdominal pain without objective findings. Main Outcome Measurements: ERCP success and failure rates, findings, interventions, complications, and outcomes were determined. Data were compared between group I and group II. Results: A total of 185 consecutive children with abdominal pain who underwent ERCP were identified (131 in group I and 54 in group II). ERCP technical success was achieved in 98%. In group I, ERCP identified a cause for abdominal pain in 93 of 129 children (72%). Fifty-four of 93 patients (58%) in this group underwent endoscopic intervention with resolution of pain. In group II, a cause for abdominal pain was identified in 30 of 53 children (56%)(P <.025 compared with group I). Fourteen of 30 patients (47%) in this group underwent endoscopic intervention with resolution of pain. Complications noted were mild pancreatitis in two and self-limited bleeding in one. Limitations: A retrospective study, One tertiary center where the majority of the ERCPs were performed by one experienced operator. Conclusions: ERCP in children with abdominal pain suggestive of a pancreatobiliary origin has a favorable risk:benefit ratio. (Gastrointest Endosc 2008;68:1081-5.)