The increasing role of ERCP in the management of pediatric pancreatitis

R. K. Hsu, P. R. Tarnasky, A. Yu, P. Dragonov, John T Cunningham, R. H. Hawes, J. W. Leung, P. B. Cotton

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Abstract

Introduction: ERCP plays an increasingly important role in the management of pancreatitis in children. Broader range of diagnostic and therapeutic maneuvers can be effectively applied. This study reviewed the results of our ERCP experience in managing this patient population. Method: From 4/94 to 12/96, ERCP performed for pancreatitis in two teaching institutions were prospectively followed. All the cases were performed using adult duodenoscope. The indications, findings, therapy, and complications of these procedures were reviewed. Results: 33 ERCPs were performed in 21 patients. Mean age was 11(1-18). General anesthesia was needed in 13 patients (age 1-17), conscious sedation in 7 (age 13-17). The clinical presentation includes 5 acute pancreatitis, 7 recurrent pancreatitis and 9 relapsing chronic pancreatitis. Manometry was done in 9 patients (4 abnormal). Therapeutics included sphincterotomy in 9 patients - biliary (3), minor (3), pancreatic major & minor (1), pancreatic major & biliary (1), all three (1). Stone extraction was performed in 2 patients. Stent placement in 6 patients - minor (3), biliary (2) and major (1), Pneumatic dilation was done in 1 patient. Of the eleven patients with chronic pancreatitis, 5 was mild, 2 moderate, 4 severe by the Cambridge classification. Etiologic factors include pancreas divisum(6) among which 2 had cystic fibrosis; biliary stones alone(3), papillary stenosis alone(3), choledochal cyst(2), pancreatic stones alone(2), pancreatic stricture(1), lymphoma(1), idiopathic(1), crystals(1), familial(1). Immediate complications of mild pancreatitis occurred in 2 patients; no long term complications were noted. Conclusion: ERCP findings in pancreatitis among pediatric patients are generally different from those of adult. Pancreas divisum are more frequently seen. Therapeutics can be done safely by expert endoscopists with low immediate complications. However, long term effecis of sphincterotomy in children needs further evaluation.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Pediatrics
Chronic Pancreatitis
Pancreas
Pathologic Constriction
Duodenoscopes
Choledochal Cyst
Conscious Sedation
Manometry
Therapeutics
Cystic Fibrosis
General Anesthesia
Stents
Dilatation
Lymphoma
Teaching

ASJC Scopus subject areas

  • Gastroenterology

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Hsu, R. K., Tarnasky, P. R., Yu, A., Dragonov, P., Cunningham, J. T., Hawes, R. H., ... Cotton, P. B. (1997). The increasing role of ERCP in the management of pediatric pancreatitis. Gastrointestinal Endoscopy, 45(4).

The increasing role of ERCP in the management of pediatric pancreatitis. / Hsu, R. K.; Tarnasky, P. R.; Yu, A.; Dragonov, P.; Cunningham, John T; Hawes, R. H.; Leung, J. W.; Cotton, P. B.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Hsu, RK, Tarnasky, PR, Yu, A, Dragonov, P, Cunningham, JT, Hawes, RH, Leung, JW & Cotton, PB 1997, 'The increasing role of ERCP in the management of pediatric pancreatitis', Gastrointestinal Endoscopy, vol. 45, no. 4.
Hsu, R. K. ; Tarnasky, P. R. ; Yu, A. ; Dragonov, P. ; Cunningham, John T ; Hawes, R. H. ; Leung, J. W. ; Cotton, P. B. / The increasing role of ERCP in the management of pediatric pancreatitis. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
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abstract = "Introduction: ERCP plays an increasingly important role in the management of pancreatitis in children. Broader range of diagnostic and therapeutic maneuvers can be effectively applied. This study reviewed the results of our ERCP experience in managing this patient population. Method: From 4/94 to 12/96, ERCP performed for pancreatitis in two teaching institutions were prospectively followed. All the cases were performed using adult duodenoscope. The indications, findings, therapy, and complications of these procedures were reviewed. Results: 33 ERCPs were performed in 21 patients. Mean age was 11(1-18). General anesthesia was needed in 13 patients (age 1-17), conscious sedation in 7 (age 13-17). The clinical presentation includes 5 acute pancreatitis, 7 recurrent pancreatitis and 9 relapsing chronic pancreatitis. Manometry was done in 9 patients (4 abnormal). Therapeutics included sphincterotomy in 9 patients - biliary (3), minor (3), pancreatic major & minor (1), pancreatic major & biliary (1), all three (1). Stone extraction was performed in 2 patients. Stent placement in 6 patients - minor (3), biliary (2) and major (1), Pneumatic dilation was done in 1 patient. Of the eleven patients with chronic pancreatitis, 5 was mild, 2 moderate, 4 severe by the Cambridge classification. Etiologic factors include pancreas divisum(6) among which 2 had cystic fibrosis; biliary stones alone(3), papillary stenosis alone(3), choledochal cyst(2), pancreatic stones alone(2), pancreatic stricture(1), lymphoma(1), idiopathic(1), crystals(1), familial(1). Immediate complications of mild pancreatitis occurred in 2 patients; no long term complications were noted. Conclusion: ERCP findings in pancreatitis among pediatric patients are generally different from those of adult. Pancreas divisum are more frequently seen. Therapeutics can be done safely by expert endoscopists with low immediate complications. However, long term effecis of sphincterotomy in children needs further evaluation.",
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AU - Tarnasky, P. R.

AU - Yu, A.

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AU - Cunningham, John T

AU - Hawes, R. H.

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AB - Introduction: ERCP plays an increasingly important role in the management of pancreatitis in children. Broader range of diagnostic and therapeutic maneuvers can be effectively applied. This study reviewed the results of our ERCP experience in managing this patient population. Method: From 4/94 to 12/96, ERCP performed for pancreatitis in two teaching institutions were prospectively followed. All the cases were performed using adult duodenoscope. The indications, findings, therapy, and complications of these procedures were reviewed. Results: 33 ERCPs were performed in 21 patients. Mean age was 11(1-18). General anesthesia was needed in 13 patients (age 1-17), conscious sedation in 7 (age 13-17). The clinical presentation includes 5 acute pancreatitis, 7 recurrent pancreatitis and 9 relapsing chronic pancreatitis. Manometry was done in 9 patients (4 abnormal). Therapeutics included sphincterotomy in 9 patients - biliary (3), minor (3), pancreatic major & minor (1), pancreatic major & biliary (1), all three (1). Stone extraction was performed in 2 patients. Stent placement in 6 patients - minor (3), biliary (2) and major (1), Pneumatic dilation was done in 1 patient. Of the eleven patients with chronic pancreatitis, 5 was mild, 2 moderate, 4 severe by the Cambridge classification. Etiologic factors include pancreas divisum(6) among which 2 had cystic fibrosis; biliary stones alone(3), papillary stenosis alone(3), choledochal cyst(2), pancreatic stones alone(2), pancreatic stricture(1), lymphoma(1), idiopathic(1), crystals(1), familial(1). Immediate complications of mild pancreatitis occurred in 2 patients; no long term complications were noted. Conclusion: ERCP findings in pancreatitis among pediatric patients are generally different from those of adult. Pancreas divisum are more frequently seen. Therapeutics can be done safely by expert endoscopists with low immediate complications. However, long term effecis of sphincterotomy in children needs further evaluation.

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