The purpose of this study is to determine whether a posterior fossa decompression or a posterior fossa decompression with duraplasty results in better patient outcomes with fewer complications and improved quality of life in those who have Chiari malformation type I and syringomyelia.

开始日期2016-04-01

申办/合作机构

Washington University School of Medicine

[+36]

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2023-07-01·Journal of Pediatric Gastroenterology & Nutrition

Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative

Article

作者: Quiros, J Antonio ; Huang, Clifton ; Liu, Quin Y ; Fishman, Douglas S ; Dua, Kulwinder ; Amankwah, Ernest ; Faraci, Simona ; Piester, Travis ; Torroni, Filippo ; Troendle, David M ; Morrison, John ; Barth, Bradley A ; Ruan, Wenly ; Martinez, Mercedes ; Dall'oglio, Luigi ; Kim, Kyung Mo ; Khalaf, Racha T ; Gugig, Roberto ; Mamula, Petar ; Bitton, Sam ; Wilsey, Michael ; Giefer, Matthew ; De Angelis, Paola ; Gupta, Rekha ; Zheng, Yuhua ; Werlin, Steven ; Grover, Amit ; Fox, Victor L

This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure’s success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success (P = 0.65) or adverse events rates (P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups (P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.

2023-06-01·Journal of Pediatric Gastroenterology & Nutrition

Pediatric ERCP in the Setting of Acute Pancreatitis: A Secondary Analysis of an International Multicenter Cohort Study

Article

作者: Gugig, Roberto ; Werlin, Steven L ; Dall'oglio, Luigi ; Mamula, Petar ; Troendle, David M ; Ruan, Wenly ; Giefer, Matthew ; Amankwah, Ernest ; Liu, Quin Y ; Dua, Kulwinder ; De Angelis, Paola ; Martinez, Mercedes ; Torroni, Filippo ; Fox, Victor L ; Grover, Amit ; Zheng, Yuhua ; Quiros, J Antonio ; Piester, Travis ; Fishman, Douglas S ; Bitton, Sam ; Huang, Clifton ; Kim, Kyung Mo ; Khalaf, Racha ; Faraci, Simona ; Wilsey, Michael ; Trocchia, Carolena ; Barth, Bradley A

Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.

2022-12-01·Journal of Pediatric Gastroenterology & Nutrition

Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative

Article

作者: Gugig, Roberto ; Martinez, Mercedes ; Barth, Bradley A ; Mamula, Petar ; Wilsey, Michael ; Dall'oglio, Luigi ; Torroni, Filippo ; Werlin, Steven ; Dua, Kulwinder ; Fox, Victor L ; Giefer, Matthew ; Fishman, Douglas S ; Liu, Quin Y ; De Angelis, Paola ; Zheng, Yuhua ; Faraci, Simona ; Quiros, J Antonio ; Huang, Clifton ; Ruan, Wenly ; Troendle, David M ; Kim, Kyung Mo ; Grover, Amit ; Khalaf, Racha ; Bitton, Sam

Objectives:Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs.Methods:In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events.Results:A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0–15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified.Conclusions:This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.

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