GASTROINTESTINAL ENDOSCOPYVOLUME 51,NO.4,PART 1,2000
ERCP is an established modality for the diagnosisand treatment of pancreaticobiliary diseases inadults.
Reported experience with diagnostic andtherapeutic ERCP in pediatric patients is limited.
This is due to the relatively low incidence of pancre-aticobiliary diseases (e.g.,calculi or neoplasia),limi-tations in the size of duodenoscopes,the need forgeneral anesthesia,and the lack of highly trainedand experienced endoscopists familiar with thesespecial procedures in pediatric patients.With therefinement of technique and improvement in endo-scope design,several studies have been reportedwith excellent results in the pediatric population,
especially the management of biliary diseases (bil-iary sphincterotomy to facilitate drainage or stoneextraction,
or stricture dila-tion).
Experience with pancreatic therapy is limit-ed.
We report our experience with ERCP in themanagement of pancreatitis in pediatric patients.
PATIENTS AND METHODS
Patients in this study included children who haveundergone ERCP examination for the management of pan-creatitis at two medical centers over a 32-month period(April 1994 to December 1996).The diagnosis of pancreati-tis was made on the basis of clinical presentation,serumamylase/lipase levels,abdominal sonography,or CT find-ings.The demographic information,clinical data,ERCPfindings,and complications were entered into a computerdatabase system (GI Trac,Akron Systems Development,Charleston,S.C.).All available medical records werereviewed to verify the clinical history,results of laboratory
Therapeutic ERCP in the management of pancreatitis inchildren
Ronald K.Hsu,MD,FACG,FACP,Peter Draganov,MD,Joseph W.Leung,MD,FRCP,Paul R.Tarnasky,MD,Andy S.Yu,MD,Robert H.Hawes,MD,John T.Cunningham,MD,Peter B.Cotton,MD,FRCP
Sacramento and Pleasant Hill, California, and Charleston, South Carolina
The use of diagnostic and therapeutic endoscopic retrograde cholangiopancre-atography (ERCP) is increasing in the management of pancreatobiliary diseases in children.
Over a 32-month period,we performed 34 ERCP procedures for the treatment of pan-creatitis in 22 children at two university hospitals.Demographics and clinical data and ERCP find-ings were documented.Clinical status was assessed 6 months before the first ERCP and 6 monthsafter the last ERCP,according to general condition,severity and frequency of pain,and health careencounters (emergency department visits,clinic visits,and hospital admissions related to thepancreatitis).
Mean age of the patients was 10.7 years (range 1.5 to 17 years).Abdominal pain was themain presenting symptoms with hyperamylasemia and hyperlipasemia.Clinical diagnoses includ-ed acute pancreatitis (6),recurrent pancreatitis (5),and chronic pancreatitis (11).The mean follow-up was 16.4 months.Nine patients had sphincter manometry,with abnormal results leading to bil-iary sphincterotomy in 4.Fifteen patients underwent a total of 23 therapeutic ERCP proceduresunrelated to sphincter dysfunction.There were 2 complications of 34 procedures (6%),both beingmild pancreatitis after sphincter manometry.There were no deaths.There was a significant reduc-tion in frequency (
< 0.01) and severity of pain (
< 0.01) after intervention.Patients without pan-creatographic changes of chronic pancreatitis had the most marked clinical improvement (
<0.05).In those with ductal changes of chronic pancreatitis,clinical improvement was not predict-ed by the extent of ductal changes.There was a significant decrease in health care encounters(
< 0.05) and improvement in general condition (
< 0.01) after endoscopic therapy,especially inthose with a normal pancreatogram.
Therapeutic ERCP is safe in pediatric patients with pancreatitis.Significant clinicalimprovement is achieved in patients with biliary or pancreatic stone disease.Prospective studieswith long-term follow-up are needed to determine the impact of endoscopic therapy in patients withchronic pancreatitis and sphincter of Oddi dysfunction.(Gastrointest Endosc 2000;51:396-400.)
Received February 17,1999.For revision May 18,1999.Accepted September 29,1999.From the University of California Davis Medical Center,Sacramento,California;Digestive Disease Center,Medical University of South Carolina,Charleston,South Carolina; Section of Gastroenterology,VA Northern California,Health Care System,Pleasant Hill,California.Presented at the Digestive Diseases Week,May 1997,Washington,D.C.(Gastrointest Endosc 1997;45:146).Reprint requests:Ronald Hsu,MD,FACG,FACP,University of California,Davis Medical Center,PSSB Room 3500,4150 V St.,Sacramento,CA 95817;e-mail:firstname.lastname@example.org.