Management of chronic pancreatitis in the pediatric patient: endoscopic retrograde cholangiopancreatography vs operative therapy.
OBJECTIVE
The management of chronic pancreatitis (CP) in children is challenging. We compare endoscopic retrograde cholangiopancreatography (ERCP) to operative therapy (OR).


METHODS
The study involved review of patients younger than 18 years with CP who underwent ERCP or OR from 1973 to 2007. Follow-up was complete in 95% of patients (median, 6 years; range, 1-23 years).


RESULTS
We identified 37 children with CP; 25 (68%) were managed by OR with 20 of these previously failing ERCP. Twelve (32%) were managed by ERCP alone. Mean follow-up was longer in the OR group (5.1 vs 2.1 years; P = .02). Patients with idiopathic pancreatitis (58% vs 13%; P = .04) and patients with a later onset of pancreatitis (12.0 vs 7.4 years; P = .002) were more likely to be managed with ERCP alone. The patients who underwent OR had a lower rate of recurrent pancreatitis (39% vs 75%; P < .0001), although this did not correlate to fewer hospitalizations or less narcotic use compared to ERCP alone. When patients who failed ERCP and progressed to OR were included in the ERCP alone group, ERCP was worse in recurrence (90% vs 39%; P < .0001) and rate of hospitalization (55% vs 33%; P = .04) compared to OR.


CONCLUSIONS
Patients with CP managed by OR have a lower rate of recurrent pancreatitis and hospitalization compared to ERCP.
Iqbal
C W
CW
Department of Surgery, Mayo Clinic Rochester, MN 55905, USA.
Moir
C R
CR
Ishitani
Michael B
MB
D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D050500:Pancreatitis, Chronic / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult