ERCP in the management of pancreatic diseases in children.
BACKGROUND
ERCP experience in pancreatic disorders in children is limited.


OBJECTIVE
This study evaluated the utility and efficacy of ERCP in children with pancreatic diseases at a tertiary care referral center.


METHODS
Consecutive patients 18 years of age and younger who underwent ERCP for pancreatic diseases from January 2010 to June 2011 were identified. Indications, findings, interventions, adverse events, and outcomes were recorded.


RESULTS
A total of 221 ERCPs were performed in 172 children (102 boys, mean ± standard deviation age 13.8 ± 3.2 years, 157 therapeutic). A total of 143 children (83.1%) had chronic pancreatitis (CP), 19 (11%) had recurrent acute pancreatitis (RAP), and 10 (5.8%) had acute pancreatitis (AP). Indications included pain (153, 89.4%), pancreatic fistula (11, 6.3%), symptomatic pseudocyst (4, 2.3%), and jaundice (3, 1.7%). In chronic pancreatitis patients, findings included a dilated and irregular main pancreatic duct (92, 64.3%), pancreatic duct (PD) calculi (76, 53%), dominant PD stricture (23, 16%), PD leak (7, 4.9%), pancreas divisum (35, 24.5%), and common bile duct (CBD) stricture (3, 2%). Therapeutic procedures included major papilla sphincterotomy (93, 65%), minor papilla sphincterotomy (32, 22.3%), PD stenting (77, 53.8%), and CBD stenting (3, 2.2%). PD stones larger than 5 mm were retrieved endoscopically after 57 extracorporeal shock wave lithotripsy sessions in 50 patients (34.9%). In patients with RAP, 6 (31.5%) had complete and 1 partial pancreas divisum. All underwent minor papillotomy. In patients with AP, 4 (40%) had stenting for PD leak, 2 (20%) underwent CBD clearance for biliary pancreatitis, and 4 (40%) had transpapillary pseudocyst drainage. During 13 ± 4.7 months (range 6-22 months) of follow-up, improvement of symptoms was seen in 143 of 172 (83%) patients. Procedure-related adverse events were seen in 8 (4.7%) patients.


CONCLUSIONS
Retrospective study.


CONCLUSIONS
ERCP is a safe therapeutic option for pancreatic disorders in children.
Asian Institute of Gastroenterology, Hyderabad, India.
Jaya
J
Agarwal
Asian Institute of Gastroenterology, Hyderabad, India.
D
D
Nageshwar Reddy
Asian Institute of Gastroenterology, Hyderabad, India.
Rupjyoti
R
Talukdar
Asian Institute of Gastroenterology, Hyderabad, India.
Sundeep
S
Lakhtakia
Asian Institute of Gastroenterology, Hyderabad, India.
Mohan
M
Ramchandani
Asian Institute of Gastroenterology, Hyderabad, India.
Manu
M
Tandan
Asian Institute of Gastroenterology, Hyderabad, India.
Rajesh
R
Gupta
Asian Institute of Gastroenterology, Hyderabad, India.
Nitesh
N
Pratap
Asian Institute of Gastroenterology, Hyderabad, India.
G V
GV
Rao
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003937:Diagnosis, Differential; D019468:Disease Management; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome
AE; AP; CBD; CP; ESWL; MPD; PD; RAP; SD; acute pancreatitis; adverse event; chronic pancreatitis; common bile duct; extracorporeal shock wave lithotripsy; main pancreatic duct; pancreatic duct; recurrent acute pancreatitis; standard deviation