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Pediatric endoscopic retrograde pancreatography expertise in chronic pancreatitis: a single-center analysis
Hongxi Guo1, Juan Luo2, Hu Yang1
1Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
Insights
Endoscopic retrograde pancreatography (ERP) is a safe and effective treatment for chronic pancreatitis in children, significantly reducing pain and improving outcomes. This study shows comparable complication rates to adult cases, highlighting its potential for pediatric care.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Pancreatic Diseases
Background:
- Chronic pancreatitis (CP) incidence is rising in children, presenting unique clinical challenges.
- Endoscopic retrograde pancreatography (ERP) is established for adult CP but understudied in pediatrics.
- Limited data exists on the endoscopic treatment of pediatric CP.
Purpose of the Study:
- To evaluate the safety and efficacy of ERP for treating chronic pancreatitis in pediatric patients.
- To assess clinical outcomes, complications, and long-term effects of ERP in children with CP.
Main Methods:
- Retrospective study of pediatric patients (<18 years) undergoing ERP for CP from January 2020 to October 2024.
- Data collected included demographics, etiology, diagnosis, treatment details, complications, and follow-up.
- Analysis of 17 children who underwent 34 endoscopic treatments.
Main Results:
- Recurrent abdominal pain was the primary symptom; pancreatic duct abnormalities were common.
- Pancreatic duct stent placement achieved 100% success; average 2.2 replacements needed.
- Significant reductions in pain (VAS score 6 to 1), pancreatitis episodes (2.4 to 0.6/year), and BMI improvement were observed.
- Low complication rates: postoperative pancreatitis (5.9%) and hyperamylasemia (14.7%).
Conclusions:
- Endoscopic retrograde pancreatography (ERP) is a safe and effective treatment for pediatric chronic pancreatitis.
- Standard adult endoscopes and accessories can be used by trained endoscopists.
- Complication rates in children are comparable to those reported in adult CP cases.
Background And Aim:
Chronic pancreatitis (CP) in children has exhibited an annual increase in incidence in recent years. Pediatric CP presents unique clinical features compared to adult cases. Endoscopic retrograde pancreatography (ERP) serves as a valuable and safe tool for diagnosing and treating CP in adults. However, data on endoscopic treatment of CP in children are still limited.
Methods:
Demographics, etiology, surgical indications, diagnosis, treatment details, associated complications, and follow-up information were retrospectively studied in consecutive patients (<18 years old) who underwent ERP for CP between January 2020 and October 2024.
Results:
A total of 17 children (7 male, 10 female) with a mean age of 10.0 ± 2.7 years were included in the study. A total of 34 endoscopic treatments were conducted. Recurrent abdominal pain was the primary clinical symptom. Imaging predominantly revealed pancreatic duct abnormalities such as tortuous dilatation and the presence of pancreatic duct stones. Notably, 41.2% (7 cases) involved genetic and congenital anatomical variations. Pancreatic duct stent placement was successfully performed in all 17 children (100.0% success rate). Stent replacements occurred on average 2.2 times (range 1-5) at intervals of 3-6 months. Postoperative pancreatitis developed in 2 cases (5.9%, 2/34), and hyperamylasemia occurred in 5 cases (14.7%, 5/34). The postprocedure visual analogue scale (VAS) score for abdominal pain significantly decreased from 6 to 1 (P < 0.001). The annual frequency of pancreatitis episodes showed a significant reduction, decreasing from 2.4 times pre-treatment to 0.6 times post-treatment (P < 0.05). Body mass index (BMI) also showed a significant improvement post-treatment compared to pre-treatment (P < 0.05).
Conclusions:
ERP performed by trained endoscopists utilizing standard adult endoscopes and accessories proved a safe and effective treatment option for pediatric CP, with complication rates comparable to those reported in adult cases.
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