Predictors of Prolonged Fluoroscopy Exposure in Pediatric Endoscopic Retrograde Cholangiopancreatography: Results From the Large Pediatric Endoscopic Retrograde Cholangiopancreatography Database Initiative Multicenter Cohort. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Liu, Quin Y.; Ruan, Wenly; Fishman, Douglas S.; Barth, Bradley A.; Tsai, Cynthia Man-Wai; Giefer, Matthew J.; Kim, Kyung Mo; Martinez, Mercedes; Dall'Oglio, Luigi; De Angelis, Paola; Torroni, Filippo; Faraci, Simona; Bitton, Sam; Wilsey, Michael; Khalaf, Racha T.; Werlin, Steven; Dua, Kulwinder; Huang, Clifton; Gugig, Roberto; Mamula, Petar; Fox, Victor L.; Grover, Amit S.; Quiros, J. Antonio; Zheng, Yuhua; Troendle, David M.
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 74:Issue 3(2022)
• Publication Date: 2022-03
• Subjects: Endoscopic retrograde cholangiopancreatography difficulty grade -- pancreatic endoscopic retrograde cholangiopancreatography -- pediatric endoscopy quality indicator -- radiation exposure; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000003347
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Background and Aims: Ionizing radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) is an important quality issue especially in children. We aim to identify factors associated with extended fluoroscopy time (FT) in children undergoing ERCP. Methods: ERCP on children <18 years from 15 centers were entered prospectively into a REDCap database from May 2014 until May 2018. Data were retrospectively evaluated for outcome and quality measures. A univariate and step-wise linear regression analysis was performed to identify factors associated with increased FT. Results: 1073 ERCPs performed in 816 unique patients met inclusion criteria. Median age was 12.2 years (interquartile range [IQR] 9.3–15.8). 767 (71%) patients had native papillae. The median FT was 120 seconds (IQR 60–240). Factors associated with increased FT included procedures performed on patients with chronic pancreatitis, ERCPs with American Society of Gastrointestinal Endoscopy (ASGE) difficulty grade >3, ERCPs performed by pediatric gastroenterologist (GI) with adult GI supervision, and ERCPs performed at non-free standing children's hospitals. Hispanic ethnicity was the only factor associated with lower FT. Conclusion: Several factors were associated with prolonged FTs in pediatric ERCP that differed from adult studies. This underscores that adult quality indicators cannot always be translated to pediatric patients. This data can better identify children with higher risk for radiation exposure and improve quality outcomes during pediatric ERCP.