The genesis of ERCP in medical history can be likened to that of a period, towards the tail end of the 1970s, when ERCP emerged as a revolutionary procedure for the diagnosis and therapeutic management of gastroenterological afflictions of the bile duct and pancreas. For instance, it was earlier performed on adults only but is now being performed on children as well, which is termed “pediatric ERCP”. This is quite a sensitive and complicated procedure, but if carried out under the appropriate physician, with prevailing techniques, and parental cooperation, it can be made much safer.
This article is intended especially for parents to explain what pediatric ERCP is, when it is indicated, how to prepare the child for the procedure, what is involved in the actual procedure, and what precautions are taken thereafter.
What is ERCP and How is it Performed?
An ERCP can be described as a procedure whereby a physician introduces a long and thin flexible tube via the child’s mouth into the stomach and small intestine using an endoscopic fashion. This tube is equipped with a camera and light to allow for direct visual inspection of the duct of the bile and the pancreatic duct.
The contrast agent would be injected simultaneously to clearly display on X-ray any obstruction, stones, inflammation, or tumors. If required, the doctor might be able to remove the stones through special instruments, insert a stent, or release an obstruction.
When is an ERCP Done for a Child?
Any of the following conditions involving bile duct or pancreatic problem will warrant an ERCP in a child:
- Obstruction of the bile duct or stones within the bile duct
- Pancreatitis
- Congenital anomalies
- Ductal injury due to surgery or blunt force trauma
- Infection or inflammation
In addition, children with the above problems typically show signs and symptoms such as abdominal pain, vomiting, jaundice (yellowing of the skin and eyes), and weight loss. If the doctor suspects any such problems in the bile duct or pancreas, then he/she will probably recommend an ERCP.
Parental Cooperation
The success of ERCP highly depends on the cooperation of the parents and the child during the procedure and its recovery. Therefore, parents must inquire from the doctors as much information as possible concerning the procedure: its duration, type of anesthesia to be given, postoperative downtime, and anticipated side effects.
Solid foods are not to be given to the child 6-8 hours prior to the procedure for sake of keeping an empty stomach and ensuring the safety of the child from vomiting. Medications would be timed with respect to the procedure, while those interfering with anesthesia might be withheld. The parents should highlight to the doctor any allergies experienced by their child to medications, food, or any form of anesthesia.
In the event your child happens to be suffering from cold, coughs, or any form of infections, then treat this prior to induction for anesthesia since these could cause further complications.
What Happens During an ERCP
Prior to the procedure, anesthetizing the child is performed so that he or she would feel nothing and be completely relaxed. Pediatric anesthesiologists take care of giving this anesthetic because they know exactly how to cater to the peculiar needs of children.
Once asleep, the endoscope is passed through the mouth of the child, down the esophagus into the stomach into the small intestine. From here a very tiny tube is passed into the bile duct and pancreatic duct and contrast dye injected to clearly show the problem on X-ray.
If a stone or obstruction is found, the doctor either removes it or puts in a stent to re-establish the flow of bile and/or pancreatic juice. The whole procedure takes on average 30-60 minutes long.
Postoperative Care
The child will be taken to the recovery area for observation once the procedure is done. During this time, the child will begin to wake up from anesthesia, but may remain slightly drowsy initially for a little while or complain of a dry scratchy throat.
For now, clear liquids may be given to the child if the doctor allows; otherwise, he or she may well stay in the hospital for a couple of more hours for observation just to make sure no complications arise or to ascertain that the child is pain-free.
Common things to watch out for after the procedure:
- Mild sore throat/discomfort
- Mild abdominal cramping
- Drowsiness and weakness
These are normal signs expected to clear in a couple of hours or a day or two.
Call the Doctor Immediately
Exceedingly strange signs and symptoms developing after an ERCP will have the parents rushing to call the treating doctor if their child shows any of these:
- Severe or persistent abdominal pain
- Fever or chills
- Persistent vomiting or vomiting of blood
- Yellowing of skin or eyes
- Difficulty breathing or swelling in the throat
Such symptoms might mean that the child requires urgent treatment due to incidental complications such as pancreatitis, infection, or blockage of the bile duct.
Psychological Support: Essential for Child and Parents
Entering a hospital and having a test like this can be frightening for the child. The parent must be there to assist psychologically. Explain to the child that this test will help him feel better and won’t hurt much.
A relaxed parent, full of reassurance, will make all the difference to a child with worries about the whole experience. For older children, it might help to let them watch a video or some pictures of what is going to happen in the procedure.
Diet and Resuming Normal Activities
Following an ERCP, the child should gradually progress to a normal diet, starting with light items, such as porridge or soup. Fried and spicy foods should be avoided.
It’s important to keep your child hydrated to prevent dehydration. If the doctor has prescribed any medication, be sure to administer it on time. Most children can return to their normal activities within a day or two, but strenuous physical activity or sports should be avoided for a few days.
Importance of a Follow-Up Visit
Doctors usually schedule a follow-up appointment 1 or 2 weeks after the ERCP. During this visit, they check that the duct is functioning properly, that the stent is in place, and that there is no infection.
Parents should bring all reports and a list of medications to this visit so that the doctor can make any necessary adjustments.
Safety and Success of Pediatric ERCP
With today’s modern technology and expertise, pediatric ERCP is a very safe procedure. It not only helps in diagnosis but also provides prompt treatment. Complications are rare under the guidance of a qualified gastroenterologist and an experienced anesthesiologist.
Parents should choose a trusted hospital or a certified physician with specialized facilities for pediatric care.
Conclusion
Pediatric ERCP is a cutting-edge medical procedure that is proving to be a boon in diagnosing and treating serious diseases related to the bile duct and pancreas in children. This procedure is even more successful when parents participate with complete preparation and awareness.
If your child is suffering from such a problem, there is no need to panic. Trust the doctor’s advice, provide emotional support to your child, and actively participate in their recovery process. Proper care, proper preparation, and timely treatment—these are the keys to your child’s healthy future.
