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The utility of ERCP in pediatric pancreatic trauma
Eric H Rosenfeld1, Adam M Vogel2, Denise B Klinkner3
1Texas Children's Hospital and the Michael E DeBakey, Department of Surgery, Houston, TX.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) aids in diagnosing pediatric pancreatic duct injuries and managing complications like strictures and fistulas. However, early ERCP intervention does not appear to improve recovery times for blunt pancreatic injuries in children.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Trauma management
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is used in managing pediatric pancreatic injuries, but its effectiveness is not well-established.
- Pediatric pancreatic injuries require careful management to optimize patient outcomes.
Purpose of the Study:
- To evaluate the utilization and impact of ERCP in the management of pediatric pancreatic injuries.
- To assess the effect of ERCP on patient outcomes, including recovery time and hospital stay.
Main Methods:
- Retrospective review of pancreatic injuries in children across 22 pediatric trauma centers (2010-2015).
- Collected data on ERCP procedures, indications, and patient outcomes.
- Utilized descriptive statistics and Wilcoxon rank-sum tests for analysis.
Main Results:
- ERCP was performed in 26 pediatric patients across 14 centers for indications including duct evaluation, leak control, pseudocyst, fistula, and stricture.
- ERCP influenced management or improved outcomes in 50% of patients, particularly for duct evaluation, stricture, and fistula.
- Early endoscopic intervention (stent or sphincterotomy within one week) in nonoperatively managed patients did not significantly alter time to diet, hospital days, or parenteral nutrition duration compared to observation alone.
Conclusions:
- ERCP is valuable for diagnosing duct injuries and managing late complications (stricture, fistula) in pediatric blunt pancreatic injuries.
- Early ERCP intervention for pancreatic duct disruption in children may not expedite recovery or improve outcomes.
- Further research is necessary to fully elucidate the role of ERCP in pediatric pancreatic trauma.
Background/Purpose:
Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes.
Methods:
A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests.
Results:
ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n=9) had similar time to regular diet [median (IQR)]: [10 (7-211) vs 7 (4-12) days; p=0.55], similar hospital days: [12 (8-20) vs 11 (6-19) days, p=0.63], and similar time on parenteral nutrition: [17 (10-40) vs 10 (6-18) days; p=0.19] compared to patients who were only observed.
Conclusions:
In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed.
Study Type:
Retrospective Study; Treatment Study.
Level Of Evidence:
III.
