Related Experiment Videos
Management of childhood pancreatic disorders: a multidisciplinary approach
Surender K Yachha1, Kamal Chetri, Vivek A Saraswat
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226 014, India. skyachha@sgpgi.ac.in
Insights
This study highlights a multidisciplinary approach for managing pediatric pancreatitis, combining endoscopic and radiologic interventions with surgery. Successful outcomes were achieved in children with acute and chronic pancreatitis through coordinated care.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Pediatric Surgery
Background:
- Limited data exists on therapeutic endoscopy and radiologic interventions for childhood pancreatic disorders.
- This study emphasizes a multidisciplinary approach to managing pancreatitis in children.
Purpose of the Study:
- To evaluate the effectiveness of a combined endoscopic, radiologic, and surgical approach in treating pediatric pancreatitis.
- To analyze outcomes in children with acute pancreatitis (AP) and chronic pancreatitis (CP).
Main Methods:
- Retrospective study of children with pancreatic disorders from 1992-2001.
- Diagnosis of AP and CP based on clinical, laboratory, and imaging findings, including ERCP.
- Treatment involved gastroenterologists, surgeons, and interventional radiologists.
Main Results:
- Fifteen children diagnosed with AP, CP, or pancreatic exocrine insufficiency.
- Complications of AP managed with percutaneous drainage, pancreatic duct stenting, and surgical drainage.
- CP management included pain relief with stenting, embolization for pseudoaneurysm, and surgical bypass for bile duct strictures.
Conclusions:
- A multidisciplinary strategy integrating radiologic and endoscopic interventions with surgery is crucial for successful outcomes in complicated childhood pancreatitis.
- Coordinated care improves management of diverse pancreatic conditions in pediatric patients.
Introduction:
Data on therapeutic endoscopy and radiologic interventions for the management of childhood pancreatic disorders are relatively limited. This study focuses on the multidisciplinary approach to the management of pancreatitis in children.
Patients And Methods:
Children with pancreatic disorders were studied from January 1992 to May 2001. Acute pancreatitis (AP) was diagnosed by clinical evaluation, serum amylase more than three times normal, and morphologic abnormalities of the pancreas on imaging. Children with recurrent abdominal pain, pancreatic calcification or ductal stones on imaging, and pancreatic ductal changes on endoscopic retrograde cholangiopancreatography (ERCP) were diagnosed with chronic pancreatitis (CP). Patients were treated by gastroenterologists, surgeons, and interventional radiologists. Pancreatic exocrine insufficiency was diagnosed in appropriate settings.
Results:
Fifteen children--6 with AP (posttrauma, 3; gallstone disease, 1; and viral, 1), 7 with CP, and 2 with pancreatic exocrine insufficiency--were diagnosed. Local complications observed in children with AP included pseudocyst in three, and infected acute fluid collection, right-sided pleural effusion, and ascites in one patient each. Complications of AP were managed with percutaneous catheter drainage (n = 3; pseudocyst, 2; infected fluid collection, 1), additional pancreatic duct stenting (n = 2), surgical drainage (n = 1), and octreotide for pleural effusion (n = 1). Signs of CP included abdominal pain (n = 7), obstructive jaundice resulting from lower common bile duct stricture (n = 2), and bleeding from gastroduodenal artery pseudoaneurysm (n = 1). Pancreatic duct stenting relieved pain in one patient, and steel coil embolization arrested bleeding from the pseudoaneurysm. Common bile duct strictures were managed by surgical bypass (n = 2), one of which required preoperative endoscopic bile duct stenting for management of cholangitis. Two other patients with CP required no intervention.
Conclusion:
A multidisciplinary approach of radiologic and endoscopic interventions and surgery are complimentary to each other in achieving successful outcomes of complicated childhood pancreatitis.