Eric H Rosenfeld1, Adam M Vogel2, Denise B Klinkner3, Mauricio Escobar4, Barbara Gaines5, Robert Russell6, Brendan Campbell7, Hale Wills8, Anthony Stallion9, David Juang10, Rajan K Thakkar11, Jeffrey Upperman12, Mubeen Jafri13, Randall Burd14, Bindi J Naik-Mathuria15. 1. Texas Children's Hospital and the Michael E DeBakey, Department of Surgery, Houston, TX. Electronic address: erosenfe@bcm.edu. 2. Saint Louis Children's Hospital, St. Louis, MO. 3. Mayo Clinic, Rochester, MN. 4. MultiCare Mary Bridge Children's Hospital & Health Center, Tacoma, WA. 5. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. 6. Children's of Alabama, Birmingham, AL. 7. Connecticut Children's Medical Center, Hartford, CT. 8. Hasbro Children's Hospital, Providence, RI. 9. Carolinas HealthCare System, Charlotte, NC. 10. Children's Mercy Hospital, Kansas City, MO. 11. Nationwide Children's Hospital, Columbus, OH. 12. Children's Hospital of Los Angeles, LA, CA. 13. Randall Children's Hospital at Oregon Health & Science University, Portland, OR; Doernbecher Children's Hospital Oregon Health and Science University, Portland, OR. 14. Children's National Medical Center, Washington, DC. 15. Texas Children's Hospital and the Michael E DeBakey, Department of Surgery, Houston, TX. Electronic address: bnaik@texaschildrens.org.
Abstract
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.
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.
Authors: Eric H Rosenfeld; Adam M Vogel; Mubeen Jafri; Randall Burd; Robert Russell; Marianne Beaudin; Alexis Sandler; Rajan Thakkar; Richard A Falcone; Hale Wills; Jeffrey Upperman; Rita V Burke; Mauricio A Escobar; Denise B Klinkner; Barbara A Gaines; Ankush Gosain; Brendan T Campbell; David Mooney; Anthony Stallion; Stephon J Fenton; Jose M Prince; David Juang; Nathaniel Kreykes; Bindi J Naik-Mathuria Journal: Pediatr Surg Int Date: 2019-06-03 Impact factor: 1.827
Authors: Eric H Rosenfeld; Adam Vogel; Robert T Russell; Ilan Maizlin; Denise B Klinkner; Stephanie Polites; Barbara Gaines; Christine Leeper; Stallion Anthony; Megan Waddell; Shawn St Peter; David Juang; Rajan Thakkar; Joseph Drews; Brandon Behrens; Mubeen Jafri; Randall S Burd; Marianne Beaudin; Laurence Carmant; Richard A Falcone; Suzanne Moody; Bindi J Naik-Mathuria Journal: Pediatr Surg Int Date: 2018-08-03 Impact factor: 1.827
Authors: Hannah Noemi Stundner-Ladenhauf; Leopold Bauer; Christian Heil; Josef Holzinger; Ottokar Stundner; Roman Metzger Journal: Children (Basel) Date: 2022-07-22
Authors: Federico Coccolini; Leslie Kobayashi; Yoram Kluger; Ernest E Moore; Luca Ansaloni; Walt Biffl; Ari Leppaniemi; Goran Augustin; Viktor Reva; Imitiaz Wani; Andrew Kirkpatrick; Fikri Abu-Zidan; Enrico Cicuttin; Gustavo Pereira Fraga; Carlos Ordonez; Emmanuil Pikoulis; Maria Grazia Sibilla; Ron Maier; Yosuke Matsumura; Peter T Masiakos; Vladimir Khokha; Alain Chichom Mefire; Rao Ivatury; Francesco Favi; Vassil Manchev; Massimo Sartelli; Fernando Machado; Junichi Matsumoto; Massimo Chiarugi; Catherine Arvieux; Fausto Catena; Raul Coimbra Journal: World J Emerg Surg Date: 2019-12-11 Impact factor: 5.469