Quin Y Liu1, Roberto Gugig2, David M Troendle3,4, Samuel Bitton5,6, Nishant Patel7, David S Vitale8,9, Maisam Abu-El-Haija8,9, Sohail Z Husain2, Veronique D Morinville10. 1. Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles. 2. Lucile Packard Children's Hospital at Stanford and the Department of Pediatrics, Stanford University, Palo Alto, CA. 3. UT Southwestern Medical Center. 4. Children's Health Children's Medical Center Dallas, Dallas, TX. 5. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY. 6. Division of Pediatric Gastroenterology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY. 7. Center of Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL. 8. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center. 9. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. 10. Montreal Children's Hospital, Division of Pediatric Gastroenterology and Nutrition. McGill University Health Center, Montreal, Quebec, Canada.
Abstract
INTRODUCTION: Pediatric chronic pancreatitis is increasingly diagnosed. Endoscopic methods [endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)] are useful tools to diagnose and manage chronic pancreatitis. Pediatric knowledge and use of these modalities is limited and warrants dissemination. METHODS: Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of chronic pancreatitis with special attention to studies involving 0--18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors. RESULTS: Both EUS and ERCP can be used even in small children to assist in diagnosis of chronic pancreatitis in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15 kg for EUS and 10 kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP because of lower complication rates overall. Both modalities can be used for management of chronic pancreatitis -related fluid collections. ERCP has successfully been used to manage pancreatic duct stones. CONCLUSION: EUS and ERCP can be safely used to diagnose chronic pancreatitis in pediatric patients and assist in management of chronic pancreatitis-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.
INTRODUCTION: Pediatric chronic pancreatitis is increasingly diagnosed. Endoscopic methods [endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)] are useful tools to diagnose and manage chronic pancreatitis. Pediatric knowledge and use of these modalities is limited and warrants dissemination. METHODS: Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of chronic pancreatitis with special attention to studies involving 0--18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors. RESULTS: Both EUS and ERCP can be used even in small children to assist in diagnosis of chronic pancreatitis in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15 kg for EUS and 10 kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP because of lower complication rates overall. Both modalities can be used for management of chronic pancreatitis -related fluid collections. ERCP has successfully been used to manage pancreatic duct stones. CONCLUSION: EUS and ERCP can be safely used to diagnose chronic pancreatitis in pediatric patients and assist in management of chronic pancreatitis-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.