Role of Pancreatic Endotherapy in children
Background: Pancreaticendotherapy with Endoscopic retrograde cholangio-pancreatography (ERCP) is used for several indications in adults. However, ERCP experience in children for pancreatic disorders has been limited due to multiple factors. In this study, we have reviewed all patients who underwent pancreatic endotherapy in paediatric patients, to highlight specific indications in addition to procedure safety and long term efficacy in terms of pain relief, hospital admissions and need for surgery.
Methods: This was a retrospective study done in Amrita Institute of medical sciences, Kochi. All patients (<18 years of age) who underwent ERCP for pancreatic disorders between January 2009 to December 2016 were studied. Data on patient demographics (Age, gender, and symptoms), indication and details of ERCP (Therapeutics, Number, endoprosthesis) and outcome were recorded in pre-designed proformas. Statistical analysis was carried out using SPSS software version 20.0.
Results: A total of 48 patients underwent ERCP for pancreatic disorders (Mean age 11.71 ± 4.8). Recurrent acute pancreatitis was the most common indication seen in 28 patients (58.3%). Successful cannulation was achieved in 45 patients (93.8%). Endotherapy success defined as a successful therapeutic procedure after cannulation and was achieved in 41 patients (81.4%). Older age (p-0.04) and CCP with pancreas divisum had reduced rates of endotherapy success (58%). Only 2(4.2%) patients had mild post ERCP pancreatitis. A total of 29 patients (70.7%) had pain relief on follow up and only 3(6.25%) patients required surgery.
Conclusion: Pancreatic endotherapy with ERCP is safe and efficacious in the pediatric population. CCP with abdominal pain and recurrent acute pancreatitis are the most common indications for ERCP in this population.
Keywords: Pancreas; Endoscopy; Pediatric; Endotherapy; Chronic pancreatitis; Anomalous bilio-pancreatic junction
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