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Endoscopic management of sphincter of Oddi dysfunction in children
Shyam Varadarajulu1, C Mel Wilcox
1Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294-0007, USA. svaradarajulu@yahoo.com
Insights
Pancreatic and dual sphincterotomy show promise for treating sphincter of Oddi dysfunction (SOD) in children. This endoscopic therapy appears effective and safe in a small group of pediatric patients with SOD.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Biliary and Pancreatic Disorders
Background:
- Sphincter of Oddi dysfunction (SOD) data in children is limited.
- Current treatments like biliary sphincterotomy yield suboptimal results in pediatric SOD.
- Efficacy of pancreatic or dual sphincterotomy in children with SOD remains unreported.
Purpose of the Study:
- To assess the safety and effectiveness of pancreatic and dual sphincterotomy in pediatric patients with SOD.
- To evaluate endoscopic retrograde cholangiopancreatogram (ERCP) with sphincter of Oddi manometry for SOD diagnosis in children.
Main Methods:
- Prospective study of children undergoing ERCP with sphincter of Oddi manometry for suspected SOD over 3 years.
- Diagnosis of SOD confirmed by manometry in 6 out of 11 children.
- Children with SOD underwent either pancreatic or dual sphincterotomy with prophylactic pancreatic stenting.
Main Results:
- SOD diagnosed in 6 children (mean age 11 years), presenting with pancreatitis or postcholecystectomy pain.
- Pancreatic sphincter hypertension was observed in all, biliary in 3.
- Post-procedure, 4 children were asymptomatic, 1 had partial relief, and 1 had recurrent symptoms. Mild pancreatitis occurred in one patient.
Conclusions:
- Pancreatic and dual sphincterotomy, performed by experts, is effective and safe for a subset of pediatric SOD patients.
- Further prospective, randomized trials with larger cohorts are needed to confirm endotherapy efficacy in children with SOD.
Background:
Data on sphincter of Oddi dysfunction (SOD) in children are scant. Most children diagnosed with SOD are treated by biliary sphincterotomy with suboptimal results. The efficacy and safety of pancreatic and dual sphincterotomy in children with SOD has not been previously reported.
Objective:
To evaluate the efficacy and safety of pancreatic and dual sphincterotomy in children with SOD.
Materials And Methods:
Prospective evaluation of all children who underwent endoscopic retrograde cholangiopancreatogram (ERCP) with sphincter of Oddi manometry for evaluation of suspected SOD over a 3-year period. Children diagnosed with SOD underwent pancreatic or dual sphincterotomy with prophylactic pancreatic stenting.
Results:
SOD was diagnosed by sphincter of Oddi manometry in 6 of 11 children who underwent ERCP for suspected SOD. Of the 6 children (mean age, 11 years; range, 5-16; 4 girls) with SOD, 3 presented with recurrent pancreatitis and 3 with postcholecystectomy pain. Pancreatic sphincter hypertension was noted in all 6 patients; concomitant biliary sphincter hypertension was noted in 3 patients with postcholecystectomy pain. Patients with recurrent pancreatitis underwent pancreatic sphincterotomy and those with postcholecystectomy pain underwent dual sphincterotomy. Prophylactic pancreatic stents were placed in all patients. One girl experienced mild post-ERCP pancreatitis. At a mean follow-up of 583 days (range, 325-1445), 4 patients were asymptomatic, 1 experienced partial symptom relief and 1 had recurrent symptoms.
Conclusions:
As in adults, pancreatic and dual sphincterotomy, in expert hands, is effective and safe in a subgroup of children with SOD. Prospective, randomized trials with larger number of patients are required to validate the efficacy of endotherapy in children with SOD.
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