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Functional Pancreatic Sphincter Dysfunction in Children: Recommendations for Diagnosis and Management
Tom K Lin1, Douglas S Fishman2, Matthew J Giefer3
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Journal of Pediatric Gastroenterology and Nutrition
|October 1, 2019
Summary
Functional pancreatic sphincter dysfunction (FPSD) is a rare cause of childhood pancreatitis. Guidelines suggest ruling out other causes and considering endoscopic retrograde cholangiopancreatography for select cases.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pancreatology
Background:
- Functional pancreatic sphincter dysfunction (FPSD), previously known as sphincter of Oddi dysfunction, is an uncommon cause of pancreatitis, particularly in children.
- Unlike adults, alcohol and smoking are rare risk factors in pediatric cases, and reliable diagnostic tests for FPSD in children are lacking.
- The contribution of FPSD to childhood pancreatitis remains unclear.
Purpose of the Study:
- To review diagnostic and treatment strategies for FPSD in pediatric patients.
- To identify best practices for managing children with suspected FPSD.
- To establish a consensus expert opinion on pediatric FPSD.
Main Methods:
- A comprehensive literature review was conducted focusing on diagnostic and treatment approaches for FPSD.
- The review specifically addressed challenges unique to the pediatric population.
- Consensus was formed among experts to establish best practices.
Main Results:
- In pediatric patients with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), obstructive factors must be excluded before diagnosing FPSD.
- FPSD may be indicated by a persistently dilated pancreatic duct in children with ARP/CP when no other obstructive cause is identified.
- Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy may be considered for select pediatric patients with suspected FPSD and confirmed pancreatic duct dilation, after thorough counseling.
Conclusions:
- Consensus guidelines offer a standardized approach to diagnosing and treating pediatric FPSD.
- Further research is required to fully elucidate the role of FPSD in pediatric pancreatitis.
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