90岁及以上高龄患者治疗性经内镜逆行胰胆管术的临床分析

目的探讨治疗性经内镜逆行胰胆管造影术（ERCP）在90岁及以上高龄患者中的应用指征、疗效及安全性。方法回顾性分析2001年1月1日至2014年3月31日、年龄大于或等于90岁行ERCP患者的病史资料,对其临床特征、ERCP操作情况及术后并发症进行分析。结果97例90岁及以上高龄患者共进行113次ERCP操作,包括肝外胆管结石和／或胆道感染74例、胆胰恶性疾病18例及其他胆胰良性疾病5例,插管成功率96．5％（109例次）,操作成功率92．0％（104例次）。ERCP术后并发症发生率11．5％（13例次）,病死率3．1％（3例）,其余并发症程度均较轻,能较快缓解。结论90岁及以上高龄患者行ERCP术有效而安全,但仍需更多研究支持。     

ERCP治疗肝移植术后胆道并发症的疗效评价

目的探讨ERCP在治疗肝移植术后胆道并发症方面的作用。方法回顾性分析2004年10月至2007年10月采用ERCP治疗39例肝移植术后胆道并发症患者的临床资料。对25例胆道狭窄患者（吻合口狭窄14例,非吻合口狭窄11例）行括约肌切开、胆管扩张、鼻胆管引流和塑料内支架置放术等治疗;对6例胆漏患者行鼻胆管引流及塑料内支架置放术等治疗;对16例胆道结石和胆泥形成患者（其中合并胆道狭窄8例）行括约肌切开、鼻胆管冲洗引流及取石网篮取石等治疗。结果ERCP手术成功率为95．9％（94／98）,未出现严重并发症。吻合口狭窄的ERCP治愈率为100％（14／14）,非吻合口狭窄的ERCP治愈率为27．3％（3／11）,胆漏的ERCP治愈率为83．3％（5／6）,结道结石和胆泥形成患者的ERCP治愈率为81．3％（13／16）。结论ERCP治疗肝移植术后胆道并发症安全性较高、疗效较好、严重并发症发生率较低。     

消化道清洁预防ERCP术后胆道感染的作用及机制

目的探讨口腔护理联合十二指肠冲洗在预防经内镜逆行胰胆管造影术（ERCP）术后胆道感染中的作用及机制。方法284例ERCP诊疗患者中,96例行阿米卡星干预（阿米卡星组）,95例行生理盐水干预（盐水组）,93例不加干预（对照组）。分别在十二指主乳头插管前、切开刀完成插管首次进入胆管时（即内镜操作初）和ERCP操作即将结束时（即内镜操作末）收集细菌标本并行细菌培养和菌落计数。统计分析3组ERCP术后胆管炎发生率以及不同检测点细菌检测结果。结果阿米卡星组、盐水组和对照组ERCP术后胆管炎发生率分别为7．3％（7／96）、8．4％（8／95）和18．3％（17／93）,差异有统计学意义（χ2=6．861,P=0．032）;十二指肠主乳头插管前细菌培养阳性率分别为6．3％（6／96）、25．3％（24／95）和28．0％（26／93）,差异有统计学意义（χ2=16．833,P=0．000）;内镜操作初细菌培养阳性率分别为6．3％（6／96）、16．8％（16／95）和24．7％（23／93）,差异有统计学意义（χ2=12．206,P=0．002）;内镜操作末细菌培养阳性率分别为7．3％（7／96）、17．9％（17／95）和33．3％（31／93）,差异有统计学意义（χ2=20．713,P=0．000）。结论ERCP诊疗可将肠道微生物逆行带入胆管,口腔护理联合十二指肠冲洗能减少胆管逆行微生物带入,从而能有效减少ERCP术后胆管炎的发生。     

消化道清洁对于预防内镜逆行胰胆管术后胆道感染的前瞻性随机对照研究

目的探讨口腔护理联合十二指肠冲洗对于预防ERCP术后胆道感染的作用。方法将573例梗阻性黄疸患者随机分为对照组190例（行常规ERCP诊疗）,盐水组（碘尔康漱口加生理盐水冲洗十二指肠乳头及内镜钳道,然后行ERCP诊疗）192例,抗生素组（碘尔康漱口加0．8％阿米卡星溶液冲洗后行ERCP诊疗）191例。术前收集患者临床资料,随访ERCP术后各组胆管炎发生率。结果3组在性别、年龄、梗阻部位、梗阻性质、术前总胆红素水平及白细胞计数的差异无统计学意义。对照组、盐水组及抗生素组ERCP术后胆管炎发生率分别为21．1％（40／190）、13．5％（26／192）和4．7％（9／191）,3组间差异有统计学意义（x2=22．409,P=0．000）。高、低位胆管梗阻胆管炎发生率分别为19．5％（65／333）和4．2％（10／240）,差异有统计学意义（x2=27．175,P=0．000）。而良、恶性梗阻胆管炎发生率差异无统计学意义（x2=0．449,P=0．503）。高位梗阻病例亚组分析结果示胆管炎发生率为：对照组29．7％（33／111例）、盐水组20．5％（24／117例）、抗生素组7．6％（8／105例）,3组间差异有统计学意义（x2=16．905,P=0．000）。结论高位胆管梗阻患者行ERCP诊疗更容易罹患胆管炎;在实施ERCP诊疗前,采用口腔护理联合肠道及内镜钳道冲洗能有效降低术后胆管炎的发生率,而采用抗生素溶液冲洗的效果更佳。     

ERCP插管操作模式改变的回顾性分析

目的探讨逆行胰胆管造影（ERCP）插管操作模式的转变,对于ERCP的插管成功率、术后并发症发生率及操作时间的影响。方法回顾分析2000年6月至2008年6月间因胆管疾病行诊治性ERCP的患者120例,其中选择常规插管法插管60例,使用导丝插管法插管60例。分别统计分析2组在ERCP操作过程中的目标管腔插管成功率、操作时间和术后7d内的胰腺炎及感染发生情况。结果导丝插管组患者较常规插管组的插管成功率高（P〈0．05）。除外其他因素,与常规插管相比,采用导丝插管患者的操作时间缩短。常规插管组术后胰腺炎的发病率为10．0％（6／60）,感染发生率为23．3％（14／60）;导丝插管组术后胰腺炎的发病率为3．3％（2／60）,感染发生率为10．0％（6／60）。2组均未见出血并发症的发生。结论ERCP中应用导丝进行目标管腔插管的操作模式,减少了操作的时间,显著提高了操作成功率,并降低了术后并发症发生率,但还需进一步具体研究。     

ERCP诊治胆总管结石131例回顾性分析

目的探讨内镜下逆行胰胆管造影技术（ERCP）对胆总管结石的诊治作用及并发症预防。方法对2007年1月至2011年9月期间在我院行ERCP诊治的131例胆总管结石病例进行回顾性分析,统计ERCP术中选择性胆管插管、造影、取石过程以及术后发生各种并发症情况。结果①ERCP选择性胆管插管成功率为94．6％（124/131）,胆总管结石取出成功率是96．8％（120/124）;②ERCP诊断胆总管结石准确率为96．9％（127／131）,MRCP诊断胆总管结石准确率为90．1％（118/131）：③ERCP总并发症为6．9％（9／131）：穿孔1例（0。8％）、出血2例（1．5％）和胰腺炎6例（4．6％）。结论ERCP联合MRCP是诊治胆总管结石首选的诊治方案,提高医生操作水平能减少ERCP手术并发症的发生。     

169例高龄患者行治疗性ERCP的安全性和有效性探讨

目的通过比较不同年龄段患者内镜逆行胰胆管造影（endoscopicretrogradecholangiopancre—atography,ERCP）的应用情况,分析和探讨ERCP在高龄患者中应用的有效性和安全性。方法2010年1月～2012年12月,本院进行ERCP操作的患者169例,按年龄分组,其中≥70岁的患者（高龄组）83例,〈70岁的患者（非高龄组）86例。记录患者ASA分级、基础疾病、ERCP操作以及并发症情况,对结果进行统计分析。结果169例患者进行了181次ERCP操作。例数、性别比例在两组间差异无统计学意义（P〉0．05）。ERCP操作成功率、并发症发生率两组比较差异无统计学意义（P〉0．05）。高龄组患者ASA分级比非高龄组高,差异有统计学意义（P〈0．05）。高龄组胆道系统结石及胰腺或胆道恶性肿瘤显著高于非高龄组（P〈0．05）。结论高龄组进行ERCP操作能够取得和非高龄组一样的疗效,ERCP在高龄患者中的应用是安全、有效的。     

经内镜逆行胰胆管造影术后并发胰腺炎的危险因素分析

目的探讨发生经内镜逆行胰胆管造影术（ERCP）术后胰腺炎（PEP）的危险因素。方法回顾性分析4234例接受ERCP诊疗患者的临床资料,提取患者年龄、性别、手术史、重大疾病史等基本信息以及术前实验室检查、腹部彩超、CT、磁共振胰胆管成像等检查结果,详细录入ERCP术中操作、术中诊断、并发症以及术后处理等情况,运用单因素分析和多因素分析手段分别寻找PEP发生的危险因素和独立危险因素,并采用矩阵相关分析方法探寻各危险因素之间是否存在共线性关系。结果共发生226例PEP,发生率为5．3％。单因素分析显示女性（X^2=9．715,P=0．002）、年龄〈60岁（X^2=6．108,P=0．013）、慢性胰腺炎（X^2=14．703,P=0．001）、初次ERCP（X^2=14．899,P=0．000）、高血压（X^2=4．489,P=0．034）、术前黄疸阴性（X^2=19．159,P=0．000）、困难插管（X^2=45．824,P=0．000）、留置胰管导丝（X^2=30．223,P=0．000）、乳头预切开（X^2=45．928,P=0．000）、胰管造影（X^2=20．170,P=0．000）为PEP发生的危险因素。多因素非条件Logistic回归分析显示女性（OR=1．449,P=0．011）、初次ERCP（OR=1．745,P=0．003）、术前黄疸阴性（OR=1．917,P=0．000）、困难插管（OR=3．317,P=0．ooo）以及胰管造影（OR=1．823,P=0．004）为PEP发生的独立危险因素。矩阵相关分析提示困难插管与乳头预切开、留置胰管导丝之间存在一定的共线性,相关系数分别为-0．788和-0．699。结论女性、年龄〈60岁、慢性胰腺炎、初次ERCP、高血压、术前黄疸阴性、困难插管、留置胰管导丝、乳头预切开、胰管造影均可能引发PEP。其中术前黄疸阴性、初次ERCP、女性患者、困难插管和胰管造影是PEP的独立危险因素,而留置胰管导丝和乳头预切开因与困难插管密切相关,故不应当视为独立的危险因素。     

盐酸屈他维林在ERCP术前应用价值的多中心随机对照试验

目的比较ERCP术前应用盐酸屈他维林和东莨菪碱抑制十二指肠蠕动的效果，探讨ERCP术前应用盐酸屈他维林的有效性和安全性。方法4个消化内镜中心共650例患者纳入研究，按1：1的比例随机分成屈他维林组和东莨菪碱组。ERCP术前15min分别给予盐酸屈他维林40mg或东莨菪碱20mg静推，观察十二指肠收缩评分、插管成功率、不良反应及术后并发症等。结果638例患者完成试验，屈他维林组和东莨菪碱组各319例，2组平均十二指肠收缩评分[（1．13±0．89）分比（1．17±0．82）分]、插管成功率[91．8％（293／319）比90．9％（290／319）]、术后并发症发生率[11．0％（35／319）比11．3％（36／319）]等比较差异均无统计学意义（P值分别为0．705、0．672和0．900），而屈他维林组术中心率〉120次／min的发生率明显低于东莨菪碱组[2．2％（7／319）比6．9％（22／319），P=0．004]，2组其它不良反应的发生率比较差异均无统计学意义（P均〉0．05）。结论盐酸屈他维林在ERCP术中有较好的解痉效果，不良反应少，可考虑作为术前常规用药选择。     

儿童经内镜逆行胰胆管造影术61例临床分析

目的 探讨儿童经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）的主要适应证及主要并发症的危险因素。方法 2010—2017年于北京友谊医院内镜中心行ERCP诊治的年龄≤14岁胆胰疾病患儿61例,共行ERCP操作101例次,回顾分析行ERCP的病因、麻醉方式、操作成功率、并发症发生率等情况,对主要并发症的影响因素先后行单因素分析和多因素Logistic回归分析。结果 101例次操作中成功97例次,成功率为96.0%。慢性胰腺炎（68.3%,69/101）、胰腺分裂（11.9%,12/101）、胆管结石（8.9%,9/101）分别占适应证的前3位。总体并发症发生率为32.7%（33/101）,以高淀粉酶血症（13.9%,14/101）及术后胰腺炎（13.9%,14/101）最常见。多因素Logistic回归分析发现慢性胰腺炎与高淀粉酶血症及术后胰腺炎呈负相关（P＜0.01,OR=0.020,95%CI：0.002～0.160）,而胰腺分裂（P＜0.01,OR=7.4,95%CI：1.4～37.9）、胰管插管（P＜0.01,OR=79.7,95%CI：6.5～972.6）为高淀粉酶血症及术后胰腺炎的独立危险因素。结论 儿童行ERCP以慢性胰腺炎为主要适应证,总体操作成功率较高,但相关并发症发生率不低,尤其在一些特殊患儿（如胰腺分裂）的操作过程中应当引起重视。     

Complications of endoscopic retrograde cholangiography in the post-MRCP era： A tertiary center experience

AIM: To evaluate our experience in endoscopic retrograde cholangio-pancreatography (ERCP) in terms of fulfilling the ASGE guidelines in indications, positive findings, and complications in the post-magnetic resonance cholangiopancreatography (MRCP) era. METHODS: Between November 2001 and February 2003, consecutive ERCP cases were prospectively evaluated with regard to the indications, findings, cannulation techniques, devices used during the procedure, sedation given, duration of procedure, and complications. These data were entered in a database for subsequent processing and analysis. RESULTS: Of 336 cases, 21.4% were diagnostic and 78.6% therapeutic ERCP. The indications for ERCP fulfilled the ASGE guidelines in 323 cases (96.1%). Suspected bile duct stone was the most frequent indication (26.8%), and this was followed by cholangitis (24.4%), dilated common bile duct (14.9%), and cholestatic jaundice (13.4%). Cannulation success rate was 94%. Biliary sphincterotomy was performed in 175 (52.1%) patients. Repeated ERCP was performed on 31.5% of the patients. Overall, the complication rate was 9.8% with 0.3% being procedure-related mortality. The complications were pancreatitis (5.4%), bleeding (0.8%), cholangitis (2.4%) and others (1.5%). No significant difference was observed between the complication rate and the type of ERCP performed. CONCLUSION: Our study showed that post-ERCP complication rate was comparable with the other large prospective studies and there was no difference in the complication between the diagnostic and therapeutic ERCP.     

经胰管弓式隔膜乳头预切开术和针式乳头预切开术在困难胆管插管中的应用研究

目的评价经胰管弓式隔膜乳头预切开术处理ERCP困难胆管插管的应用价值。方法回顾2006年1月至2008年7月109例ERCP胆总管插管困难患者进行经胰管弓式隔膜乳头预切开术（下称经胰管组,56例）和常规针式乳头预切开术（下称常规针刀组,53例）的临床资料,比较两种方法插管成功率及并发症发生率。结果109例患者中的97例在乳头预切开术后可成功插入胆管,经胰管组成功率96．4％（54／56）,常规针刀组成功率81．1％（43／53）,两者差异具统计学意义（P〈0．05）。109例中11例出现并发症,包括急性胰腺炎5例、出血4例、胆道感染2例。其中,经胰管组急性胰腺炎2例,常规针刀组急性胰腺炎3例,出血4例,胆道感染2例。两组比较,经胰管组总的并发症发生率低于常规针刀组（3．6％比17．0％,P〈0．05）,术后胰腺炎、出血、感染发生率也分别低于后者,但均无统计学意义。结论内镜经胰管弓式隔膜乳头预切开术超选胆总管成功率高于针式乳头预切开术,而且并发症较低,是处理选择性胆总管插管较困难患者的安全和有效的办法。     

Role of prophylactic endoscopic sphincterotomy in patients with acute biliary pancreatitis due to transient common bile duct obstruction

BACKGROUND AND AIM: The role of prophylactic endoscopic sphincterotomy in patients with transient common bile duct obstruction is controversial. The aim of this study was to assess the value of performing prophylactic endoscopic sphincterotomy in patients suffering from acute biliary pancreatitis and absent common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Hospital notes of patients admitted to our unit with a diagnosis of acute pancreatitis from January 2000 to January 2005 were reviewed. Endoscopic sphincterotomy was performed when patients were deemed unfit for cholecystectomy, suffering from a severe attack of acute pancreatitis and/or showing evidence of transient common bile duct obstruction. The outcomes of patients with and without endoscopic sphincterotomy were compared. RESULTS: A total of 427 patients were admitted with a diagnosis of acute pancreatitis during the study period. Eighty-eight patients with absent common bile duct stones on ERCP were identified. Endoscopic sphincterotomy was performed in 71 patients and not performed in 17 patients. There was no significant difference in recurrent pancreatitis rates (1.4% vs 5.8%, P = 0.35), recurrent biliary complication rates (5.6% vs 5.9%, P = 1) or mortality rates (5.8% vs 1.5%, P = 0.35). The time to recurrent complications (38.4 days vs 41.0 days, P = 0.38) was not significantly different between the two groups. There was no ERCP-related morbidity or mortality. CONCLUSION: Prophylactic endoscopic sphincterotomy is not recommended in patients with transient common bile duct obstruction or as an option to cholecystectomy in elderly patients. Early cholecystectomy should be performed.     

Outcomes of bile duct drainage by means of ERCP in geriatric patients]

BACKGROUND AND OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is usually the procedure of choice for relieving bile duct obstruction. a large number of patients undergoing this intervention are geriatric population (aged 75 years of age and older). Our aim was to assess the efficacy of ERCP in this group of patients as compared to younger ones. PATIENTS AND METHODS: A retrospective study. All patients in whom a therapeutic biliary endoscopy had been performed over a four-year period of time (2002-2005) were included. RESULTS: 178 geriatric patients and 159 younger ones underwent ERCP. No differences were found in successful biliary drainage (97.7 vs. 98.7%), complication number (11.8 vs. 14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand, more common bile duct stones were found in geriatric patients (57.3 vs. 39.6%, p = 0.004), and also more self-expanding metal stents were employed to drain malignant obstructive jaundice (47 vs. 8%, p = 0.0035). In the youngest group, more ERCPs were repeated in the same patients (4 vs. 10%, p = 0.001). CONCLUSIONS: The geriatric population showed similar success and morbidity and mortality rates when compared to younger patients in draining their bile duct by means of ERCP. Common bile duct stones were more frequently found in geriatric patients. No patients needing an ERCP should be excluded only because of their age.     

Findings and Risk Factors of Early Mortality of Endoscopic Retrograde Cholangiopancreatography in Different Cohorts of Elderly Patients

OBJECTIVES: To analyze experience of endoscopic retrograde cholangiopancreatography (ERCP) in patients with of different age cohorts and discuss the risk factors of early mortality after ERCP.
DESIGN: Retrospective study.
SETTING: Tertiary care medical center.
PARTICIPANTS: Two hundred sixty-four patients with pancreatobiliary diseases divided into cohorts according to decades as young-old (YO, 65–74, n=143), old-old (OO, 75–84, n=88), and very-old (VO, ≥85, n=33).
MEASUREMENTS: The indications, results, and complications of ERCP in these three groups were demonstrated and compared.
RESULTS: Three hundred three ERCP procedures were performed. The leading indication for ERCP was common bile duct (CBD) obstruction or dilation. Diabetes mellitus was significantly more prevalent in the YO group (39.2%) than in the other two groups (OO, 15.9%; VO, 24.2%; P =.001). The most common finding of ERCP was CBD dilatation. There was no difference in incidence of malignant diseases between the three groups. Acute pancreatitis was the most frequently identified post-ERCP complication. There was no significant difference in early mortality between the three cohorts. Patients with malignancy had higher early mortality than those with benign disease (71.4% vs 11.2%; P =.001).
CONCLUSION: The findings and incidences of complication of ERCP in different elderly cohorts were similar. Underlying malignancy seemed to bear some relation to early mortality after the ERCP procedure.     

十二指肠乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的疗效评价

目的 探讨乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的效果和安全性.方法 将2008年3月至2009年12月收治的难治性胆总管结石患者随机分为两组,分别为乳头括约肌切开组及乳头括约肌小切开联合气囊扩张组,比较两组间结石取净率、取石次数、机械碎石使用率、并发症发生率.结果 两组间结石取净率、早期并发症发生率,差异无统计学意义（2/61比2/62,6/61比4/62;P＞0.05）;乳头括约肌切开组需多次及需要使用机械碎石才能取净结石的比例以高于乳头括约肌小切开联合气囊扩张组,率差异有统计学意义（15/61比5/62,12/6l比4/62;P＜0.05）.结论 乳头括约肌小切开联合气囊扩张与乳头括约肌切开两种方法同样安全有效;乳头括约肌小切开联合气囊扩张操作更简便.     

ERCP in patients 90 years of age and older

BACKGROUND: Biliary diseases represent particular diagnostic and therapeutic problems in elderly patients. METHODS: Patients 90 years of age or older who underwent ERCP from January 1993 to September 2001 were studied retrospectively. RESULTS: A total of 126 patients underwent 147 ERCP procedures (range 1-5 per patient). Twelve additional ERCPs were performed in 9 of the patients during follow-up because of recurrent symptoms. A total of 159 procedures were, therefore, available for analysis. The most frequent indications were suspicion of bile duct stones (46.8%) and obstructive jaundice (35.7%). Midazolam (95.6%) was used for conscious sedation and hyoscine (74.8%) for duodenal ileus. Patient tolerance of the procedure was good in 92.4% of sessions. Diagnoses included bile duct stones (54%), bile duct dilatation without any apparent obstruction (11.9%), and malignant stenosis (9.5%). Therapeutic procedures were indicated in 95.6% of diagnosed patients and completed in 96.3% of cases. Complications occurred in association with 2.5% of the ERCP procedures; the procedure-related mortality rate was 0.7%. CONCLUSIONS: ERCP in elderly patients is practicable. The complication rate is low, and therapeutic efficacy is good.     

Outcome and early complications of ERCP: a prospective single center study

BACKGROUND/AIMS: ERCP has been used since 1968 both as a diagnostic and as a therapeutic procedure. In the last ten years several less invasive imaging methods have developed which allow visualization of bile ducts and pancreatic ducts; therefore ERCP has become mainly a therapeutic tool. The aim of the study was to prospectively evaluate the early outcome of ERCP when used essentially as a therapeutic tool. METHODOLOGY: All patients referred to our unit between April 1 1998 and March 31 2000 were included in the study. The indication for the procedure, number of cannulations, duration of procedure, performance of endoscopic sphinterotomy or pre-cut, insertion of stent and the final outcome were recorded. All patients were visited (in-patients) or contacted by phone (outpatients) 24 hours and one week after the procedure. If a complication occurred the patient was followed until it was resolved. RESULTS: 722 ERCP procedures were performed on 534 patients (59% females), mean age 63.4 years (range 3 to 98 years). The procedure was performed with a therapeutic intention in 95% of cases because of suspicion of: cholelithiasis (58%), tumor of pancreas/bile ducts (30%), post-cholecystectomy bile leak or bile duct stenosis (6%) or treatment of chronic pancreatitis (1%). The overall success rate of selective duct cannulation was 92%. Endoscopic sphincterotomy was performed in 375 procedures (52%), pre-cut in 152 (21%) and stent inserted in 180 (25%). Among the 701 procedures with complete information 76 complications occurred in 73 patients (10.8%): pancreatitis 4.3%, perforation 1.3%, sepsis 3.7%, bleeding 1.4%. Most of the complications (63/701, 9%) were mild to moderate. Procedure-related mortality was 0.6% due to perforation (1 patient), and sepsis (3 patients). The main factors influencing the complication rate were the difficulty of the examination, performance of an invasive procedure or the operator. CONCLUSIONS: In the era of therapeutic ERCP, the risk of severe complication from the procedure is low--1.8% (including a mortality rate of 0.6%) when using the appropriate technique in experienced and skilled hands.     

Technical outcomes and complications of ERCP in children

BACKGROUND: The aim of this study was to compare the success and complications of diagnostic and therapeutic ERCP in children (age <18 years) and adult patients. METHODS: A retrospective case-controlled study was conducted in which all children undergoing ERCP at two centers (1994-2002) were identified from endoscopy databases and were matched with adult patients for all variables (e.g., indication, procedure complexity) except age. Outcomes with regard to technical success and complications were compared between the adult and the pediatric cohorts. Grade of procedure complexity and procedure-related complications were defined by using established criteria. RESULTS: A total of 116 children (mean age 9.3 years, range 1 month to 17 years; median age 8.1 years) and 116 matched adult patients (mean age 56.3 years, range 20-83 years; median age 49.7 years) underwent 163 and 173 ERCP procedures, respectively. According to procedure complexity grade, each group included the same number of patients, grade I, 72 patients; grade II, 12 patients; and grade III, 32 patients. Procedure success rate was 97.5% in children vs. 98% in the adult cohort (p= not significant). The complication rate was not significantly different between children and adult patients (3.4% vs. 2.5%). Most complications were of mild severity and encountered only in patients who underwent grade III procedures, with the exception of a single adult in whom moderate post-sphincterotomy bleeding developed after extraction of a large bile duct stone (grade II complexity). CONCLUSIONS: When ERCP is performed in children by expert endoscopists, the success rate is high and the complication rate is low, both being comparable with those for ERCP in adult patients.