Endoscopic Retrograde Cholangio-Pancreatography in Children: Retrospective Audit at the Largest Tertiary Pediatric Institution in Singapore.

Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool in the management of pancreaticobiliary disorders. However, experience in pediatric ERCP is limited and criteria for competency remain undefined. In this retrospective single-center audit, we reviewed the indications, success rates, and adverse events associated with pediatric ERCP at the largest pediatric hospital in Singapore. Methods: Medical records of patients aged 0-18 years who underwent ERCP between 2014 and 2024 were reviewed. All procedures were performed by endoscopists routinely treating adults. Data on demographics, medical history, indications and findings of ERCP, operative procedures, and adverse events were collected. Results: Thirty-eight ERCP procedures were performed on 20 patients. The youngest patient was 19 months of age and weighed 8 kg. The median patient age was 12 years (2-17) years. Biliary obstruction was the most common indication (18/38 [47.8%]). The cannulation and technical success rates were both 94.7% (36/38). More than half of the patients underwent complex endoscopic procedures of at least American Society for Gastrointestinal Endoscopy level 3 complexity. Complications occurred in 4 of 38 (10.5%) procedures, including post-ERCP cholangitis, pancreatic duct perforation, post-ERCP pancreatitis, and post-sphincterotomy bleeding. Conclusion: Pediatric ERCP performed by experienced endoscopists routinely treating adults was successful and safe even in a low-volume setting with complex interventions.