Therapeutic ERCP in the management of pancreatitis in children

Ronald K. Hsu, Peter Draganov, Joseph Leung, Paul R. Tarnasky, Andy S. Yu, Robert H. Hawes, John T. Cunningham, Peter B. Cotton

Research output: Contribution to journalArticle

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Abstract

Background: The use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is increasing in the management of pancreatobiliary diseases in children. Methods: Over a 32-month period, we performed 34 ERCP procedures for the treatment of pancreatitis in 22 children at two university hospitals. Demographics and clinical data and ERCP findings were documented. Clinical status was assessed 6 months before the first ERCP and 6 months after the last ERCP, according to general condition, severity and frequency of pain, and health care encounters (emergency department visits, clinic visits, and hospital admissions related to the pancreatitis). Results: Mean age of the patients was 10.7 years (range 1.5 to 17 years). Abdominal pain was the main presenting symptoms with hyperamylasemia and hyperlipasemia. Clinical diagnoses included 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 biliary sphincterotomy in 4. Fifteen patients underwent a total of 23 therapeutic ERCP procedures unrelated to sphincter dysfunction. There were 2 complications of 34 procedures (6%), both being mild pancreatitis after sphincter manometry. There were no deaths. There was a significant reduction in frequency (p < 0.01) and severity of pain (p < 0.01) after intervention. Patients without pancreatographic changes of chronic pancreatitis had the most marked clinical improvement (p < 0.05). In those with ductal changes of chronic pancreatitis, clinical improvement was not predicted by the extent of ductal changes. There was a significant decrease in health care encounters (p < 0.05) and improvement in general condition (p < 0.01) after endoscopic therapy, especially in those with a normal pancreatogram. Conclusions: Therapeutic ERCP is safe in pediatric patients with pancreatitis. Significant clinical improvement is achieved in patients with biliary or pancreatic stone disease. Prospective studies with long-term follow-up are needed to determine the impact of endoscopic therapy in patients with chronic pancreatitis and sphincter of Oddi dysfunction.

Original languageEnglish (US)
Pages (from-to)396-400
Number of pages5
JournalGastrointestinal Endoscopy
Volume51
Issue number4 I
StatePublished - 2000

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Chronic Pancreatitis
Manometry
Therapeutics
Sphincter of Oddi Dysfunction
Hyperamylasemia
Delivery of Health Care
Pain
Pancreatic Diseases
Therapeutic Uses
Ambulatory Care
Disease Management
Abdominal Pain
Hospital Emergency Service
Demography
Prospective Studies
Pediatrics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Hsu, R. K., Draganov, P., Leung, J., Tarnasky, P. R., Yu, A. S., Hawes, R. H., ... Cotton, P. B. (2000). Therapeutic ERCP in the management of pancreatitis in children. Gastrointestinal Endoscopy, 51(4 I), 396-400.

Therapeutic ERCP in the management of pancreatitis in children. / Hsu, Ronald K.; Draganov, Peter; Leung, Joseph; Tarnasky, Paul R.; Yu, Andy S.; Hawes, Robert H.; Cunningham, John T.; Cotton, Peter B.

In: Gastrointestinal Endoscopy, Vol. 51, No. 4 I, 2000, p. 396-400.

Research output: Contribution to journalArticle

Hsu, RK, Draganov, P, Leung, J, Tarnasky, PR, Yu, AS, Hawes, RH, Cunningham, JT & Cotton, PB 2000, 'Therapeutic ERCP in the management of pancreatitis in children', Gastrointestinal Endoscopy, vol. 51, no. 4 I, pp. 396-400.
Hsu RK, Draganov P, Leung J, Tarnasky PR, Yu AS, Hawes RH et al. Therapeutic ERCP in the management of pancreatitis in children. Gastrointestinal Endoscopy. 2000;51(4 I):396-400.
Hsu, Ronald K. ; Draganov, Peter ; Leung, Joseph ; Tarnasky, Paul R. ; Yu, Andy S. ; Hawes, Robert H. ; Cunningham, John T. ; Cotton, Peter B. / Therapeutic ERCP in the management of pancreatitis in children. In: Gastrointestinal Endoscopy. 2000 ; Vol. 51, No. 4 I. pp. 396-400.
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abstract = "Background: The use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is increasing in the management of pancreatobiliary diseases in children. Methods: Over a 32-month period, we performed 34 ERCP procedures for the treatment of pancreatitis in 22 children at two university hospitals. Demographics and clinical data and ERCP findings were documented. Clinical status was assessed 6 months before the first ERCP and 6 months after the last ERCP, according to general condition, severity and frequency of pain, and health care encounters (emergency department visits, clinic visits, and hospital admissions related to the pancreatitis). Results: Mean age of the patients was 10.7 years (range 1.5 to 17 years). Abdominal pain was the main presenting symptoms with hyperamylasemia and hyperlipasemia. Clinical diagnoses included 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 biliary sphincterotomy in 4. Fifteen patients underwent a total of 23 therapeutic ERCP procedures unrelated to sphincter dysfunction. There were 2 complications of 34 procedures (6{\%}), both being mild pancreatitis after sphincter manometry. There were no deaths. There was a significant reduction in frequency (p < 0.01) and severity of pain (p < 0.01) after intervention. Patients without pancreatographic changes of chronic pancreatitis had the most marked clinical improvement (p < 0.05). In those with ductal changes of chronic pancreatitis, clinical improvement was not predicted by the extent of ductal changes. There was a significant decrease in health care encounters (p < 0.05) and improvement in general condition (p < 0.01) after endoscopic therapy, especially in those with a normal pancreatogram. Conclusions: Therapeutic ERCP is safe in pediatric patients with pancreatitis. Significant clinical improvement is achieved in patients with biliary or pancreatic stone disease. Prospective studies with long-term follow-up are needed to determine the impact of endoscopic therapy in patients with chronic pancreatitis and sphincter of Oddi dysfunction.",
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AB - Background: The use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is increasing in the management of pancreatobiliary diseases in children. Methods: Over a 32-month period, we performed 34 ERCP procedures for the treatment of pancreatitis in 22 children at two university hospitals. Demographics and clinical data and ERCP findings were documented. Clinical status was assessed 6 months before the first ERCP and 6 months after the last ERCP, according to general condition, severity and frequency of pain, and health care encounters (emergency department visits, clinic visits, and hospital admissions related to the pancreatitis). Results: Mean age of the patients was 10.7 years (range 1.5 to 17 years). Abdominal pain was the main presenting symptoms with hyperamylasemia and hyperlipasemia. Clinical diagnoses included 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 biliary sphincterotomy in 4. Fifteen patients underwent a total of 23 therapeutic ERCP procedures unrelated to sphincter dysfunction. There were 2 complications of 34 procedures (6%), both being mild pancreatitis after sphincter manometry. There were no deaths. There was a significant reduction in frequency (p < 0.01) and severity of pain (p < 0.01) after intervention. Patients without pancreatographic changes of chronic pancreatitis had the most marked clinical improvement (p < 0.05). In those with ductal changes of chronic pancreatitis, clinical improvement was not predicted by the extent of ductal changes. There was a significant decrease in health care encounters (p < 0.05) and improvement in general condition (p < 0.01) after endoscopic therapy, especially in those with a normal pancreatogram. Conclusions: Therapeutic ERCP is safe in pediatric patients with pancreatitis. Significant clinical improvement is achieved in patients with biliary or pancreatic stone disease. Prospective studies with long-term follow-up are needed to determine the impact of endoscopic therapy in patients with chronic pancreatitis and sphincter of Oddi dysfunction.

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