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ERCP in the management of pediatric pancreatitis
K S Graham1, J D Ingram, S E Steinberg
1Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) findings significantly alter management for pediatric pancreatitis. Abnormalities detected by ERCP led to therapy changes in over half of the children studied, highlighting its clinical utility.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used in pediatric patients.
- The impact of ERCP findings on the management of pediatric pancreatitis remains unclear.
Purpose of the Study:
- To determine how findings from ERCP influence the subsequent management of children with recurrent acute or chronic pancreatitis.
Main Methods:
- A retrospective chart review of 17 pediatric patients (3 boys, 14 girls; ages 3-16) with recurrent acute or chronic pancreatitis who underwent ERCP.
- Blinded review of radiographic findings and assessment of ERCP's effect on patient management.
Main Results:
- Successful pancreatic duct visualization was achieved in 94% of patients.
- Abnormal findings were present in 56% of ERCP studies, leading to therapy changes in all affected patients.
- ERCP findings altered management in 52% of pediatric pancreatitis cases; prior CT scans showed high predictive value for management changes (83%).
Conclusions:
- ERCP is a valuable tool in managing pediatric recurrent acute or chronic pancreatitis.
- The rate of abnormalities detected via ERCP in children is comparable to that observed in adult populations.
Background:
Although ERCP is commonly performed in children, the effect of findings at ERCP on the subsequent management of pediatric pancreatitis is unknown.
Methods:
We retrospectively reviewed charts to determine the impact of ERCP on the management of recurrent acute or chronic pancreatitis in 17 consecutive children (3 boys and 14 girls, 3 to 16 years, mean 11.2 years) with recurrent acute (n = 13) or chronic pancreatitis (n = 4) who underwent ERCP. Radiographs were reviewed in a blinded manner, and the effect of ERCP findings on subsequent management was determined.
Results:
In 16 of 17 patients (94%), the pancreatic duct was successfully visualized. Of the 16 studies, 9 (56%) had abnormal findings. A change in therapy occurred in all 9 patients as a result of the findings at ERCP. Of the 7 patients with a prior abnormal CT or ultrasound, 5 (71%) had an abnormal ERCP, all resulting in a change in therapy. Three of the 9 patients (33%) without radiographic abnormalities had an abnormal ERCP that, in each case, resulted in a change in therapy. Overall, findings at ERCP altered therapy in 52% of pediatric patients studied with recurrent acute or chronic pancreatitis. A prior abnormal CT had a high predictive value with respect to ERCP resulting in a change in management (83%).
Conclusions:
ERCP is useful in the management of pediatric recurrent acute or chronic pancreatitis; abnormalities are found at a rate similar to those found in adults.
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