The Roles of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Evaluation and Treatment of Chronic Pancreatitis in Children

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.

EUS in Pediatrics: A Multicenter Experience and Review

“…The incidence of pancreatitis in children is increasing ( 20 , 21 ). EUS for pancreatitis is traditionally used in a diagnostic capacity to evaluate for potential etiologies for idiopathic acute recurrent pancreatitis (ARP) as well as to characterize changes associated with chronic pancreatitis (CP) ( 12 ). EUS has been shown to offer increased sensitivity for microlithiasis and gallstones that may explain ARP ( 22 ).…”

“…Esophageal intubation of a small child with a standard EUS scope carries an increased risk of cervical esophageal perforation. Nevertheless, there are studies reporting successful EUS in children <1 year of age, with echoendoscopes usually safely utilized in children as small as 15 kg ( 4 , 5 , 12 ). In our experience, we have successfully performed therapeutic EUS in children as small as 12 kg.…”

Pleural effusion secondary to chronic pancreatitis in childhood

“…Endoscopic pancreatic stenting has been shown to effectively resolve the PPF [17,18]. ERCP is a safe procedure with low risk of bleeding (<1%) in children [19,20]. In two small studies of children with pancreatic duct disruption and PPF, ERCP and stenting procedures were successful in 80% of cases [21,22].…”

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children

“…One of the major complications of ERCP is PEP, which occurs in children with a frequency of 5-12%. 5,17,21,69,[79][80][81] Iqbal et al reported that pancreatitis was more frequent in therapeutic ERCP than diagnostic ERCP, and had an overall frequency of 2.5%. 82 In order to prevent PEP, it is necessary to understand known risk factors and take preventive measures for PEP.…”

“…Unlike other methods, ERCP has the advantage of being able to diagnose as well as simultaneously provide treatment. EUS should be considered in the evaluation of pediatric patients with suspected CP when findings of cross‐sectional imaging are insufficient 69 …”