Practice patterns and outcomes of pediatric ERCP using conventional duodenoscopes: a 14-year single-center experience

Endoscopic retrograde cholangiopancreatography (ERCP) is an established therapeutic modality in children with pancreatobiliary disorders. Because pediatric-specific duodenoscopes are not widely available, conventional adult duodenoscopes are commonly used in clinical practice. We evaluated clinical outcomes of pediatric ERCP performed using conventional duodenoscopes at a tertiary referral center. This retrospective study included pediatric patients younger than 19 years who underwent ERCP using conventional duodenoscopes at a tertiary referral center over a 14-year period. Demographic characteristics, indications, procedural details, sedation methods, technical success, and ERCP-related adverse events, including post-ERCP pancreatitis (PEP), were analyzed. Sedation was administered according to institutional protocols and categorized as moderate to deep sedation based on American Society of Anesthesiologists definitions. A total of 82 patients underwent 153 ERCP procedures, including 28 procedures performed in children aged 1–6 years. The technical success rate was 91.5%. Procedure-related adverse events occurred in 46 procedures (30.1%), most of which were mild to moderate. PEP was the most common adverse event (22 procedures, 14.4%). There were no severe adverse events or mortality. In multivariable analysis, younger age was independently associated with an increased risk of PEP (odds ratio 0.81, 95% CI 0.71–0.93; p = 0.003). Pediatric ERCP using conventional duodenoscopes achieved high technical success with an acceptable safety profile. Younger age was independently associated with PEP and may serve as a useful risk stratification factor. Although pediatric-specific duodenoscopes remain preferable, conventional duodenoscopes may be a reasonable alternative in selected patients when pediatric scopes are unavailable.