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Background: ERCP has become widely available for the diagnosis and treatment of benign and malignant pancreaticobiliary diseases. In this prospective study, the overall complication rate and risk factors for diagnostic and therapeutic ERCP were identified., Methods: Data were collected prospectively on patient characteristics and endoscopic techniques from 1223 ERCPs performed at a single referral center and entered into a database. Univariate and multivariate analyses were used to identify risk factors for ERCP-associated complications., Results: Of 1223 ERCPs performed, 554 (45.3%) were diagnostic and 667 (54.7%) therapeutic. The overall complication rate was 11.2%. Post-ERCP pancreatitis was the most common (7.2%) and in 93% of cases was self-limiting, requiring only conservative treatment. Bleeding occurred in 10 patients (0.8%) and was related to a therapeutic procedure in all cases. Nine patients had cholangitis develop, most cases being secondary to incomplete drainage. There was one perforation (0.08%). All other complications totaled 1.5%. Variables derived from cannulation technique associated with an increased risk for post-ERCP pancreatitis were precut access papillotomy (20%), multiple cannulation attempts (14.9%), sphincterotome use to achieve cannulation (13.1%), pancreatic duct manipulation (13%), multiple pancreatic injections (12.3%), guidewire use to achieve cannulation (10.2%), and the extent of pancreatic duct opacification (10%). Patient characteristics associated with an increased risk of pancreatitis were sphincter of Oddi dysfunction (21.7%) documented by manometry, previous ERCP-related pancreatitis (19%), and recurrent pancreatitis (16.2%). Pain during the procedure was an important indicator of an increased risk of post-ERCP pancreatitis (27%). Independent risk factors for post-ERCP pancreatitis were identified as a history of recurrent pancreatitis, previous ERCP-related pancreatitis, multiple cannulation attempts, pancreatic brush cytology, and pain during the procedure., Conclusions: The most frequent ERCP-related complication was pancreatitis, which was mild in the majority of patients. The frequency of post-ERCP pancreatitis was similar for both diagnostic and therapeutic procedures. Bleeding was rare and mostly associated with sphincterotomy. Other complications such as cholangitis and perforation were rare. Specific patient- and technique-related characteristics that can increase the risk of post-ERCP complications were identified.

Background: Enteral feeding by percutaneous endoscopic gastrostomy is indicated as long-term nutritional support for children with neurologic impairment and dysphagia. We report our experience with percutaneous endoscopic gastrostomy and evaluate the age range of children with cerebral palsy who benefit most with weight and height gain., Methods: In a prospective study, from August 1996 to August 1997, 20 endoscopic gastrostomies were performed in 20 children diagnosed with cerebral palsy (16), myopathy (2), and brain trauma (2). The mean age was 6.5 years and the mean follow-up 5.9 months. All patients had severe mental impairment and oropharyngeal dysphagia. They were followed up monthly on an outpatient basis by both the gastroenterologist and the dietitian, who assessed gastrostomy complications and performed anthropometric measurements., Results: All 20 patients benefited from enteral nutrition with a statistically significant gain in weight (p < 0.01), and there was a trend toward improved weight/height ratio in children under 4 years of age according to Z-score and mid-arm muscle area (p < 0.01). Triceps skinfold thickness failed to reach statistical significance. There were no immediate complications related to the procedure. Perforations occurred with three (15%) tubes, and the plugs for introduction of food had to be replaced after 4 months of use. All complications, namely formation of granulation tissue at the stoma (7), stoma infection (4), gastroesophageal reflux pneumonia (3), and pneumoperitoneum (1) were managed clinically., Conclusions: Endoscopic gastrostomy is a safe procedure for children. Enteral feeding resulted in a trend toward a normalized weight/height ratio for children with cerebral palsy younger than 4 years and significant weight gain in those older than 12 years.