Endoscopic Retrograde Cholangio-Pancreatography and Endoscopic Ultrasound in the Management of Paediatric Acute Recurrent Pancreatitis and Chronic Pancreatitis

Abstract

Objectives: To evaluate the role of ERCP (endoscopic retrograde cholangio-pancreatography) and EUS (endoscopic ultrasound) and to describe the efficacy and safety of these procedures in a paediatric cohort with chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP). Methods: All patients (<18 years) undergoing an ERCP or EUS for ARP and CP between January 2008 and December 2022 were included. Data collection included indications for the procedure, technical success, adverse events and outcome data. Results: A total of 222 ERCPs were performed in 98 patients with CP and ARP (60% female, median age 10 years). The commonest indications were a main pancreatic duct stricture (PD) with or without a stone within the main PD. Successful cannulation was achieved in 98% of cases. Improved stricture resolution was demonstrated in 63% of patients. The overall adverse event rate for ERCP was low (n = 8/222, 3.6%). An improvement in abdominal pain was demonstrated in (75/98) 76% of patients. Their Body Mass Index also significantly improved post ERCP (15.5 ± 1.41 vs. 12.9 ± 1.16 kg/m², p = 0.001). A total of 54 EUS procedures were undertaken in 48 individuals. Moreover, 35 individuals underwent a therapeutic EUS procedure, for which the commonest indication was the drainage of a pancreatic fluid collection. The overall complication rate was low (n = 2.4%) in all EUS cases. Conclusions: ERCP and EUS can be safely and effectively used in a paediatric population with indications analogous to an adult cohort.

Keywords: chronic pancreatitis; endoscopic retrograde cholangio-pancreatography; endoscopic ultrasound; paediatric; pancreatic duct stenting.

Figure 1

Aetiologies of (A) chronic pancreatitis and (B) acute recurrent pancreatitis.

Figure 2

Endoscopic retrograde cholangio-pancreatography (A–D) and endoscopic ultrasound (E–G). (A) Main pancreatic stricture with a pancreatic duct stone, (B) plastic stent, (C) fully covered metallic ‘Bumpy’ stent (black arrow), (D) Archimedes biodegradable stent (black arrow), (E) pancreatic fluid collection (white arrow), (F) endoscopic view following successful deployment of 8 × 8 mm LAMS to drain a symptomatic pancreatic fluid collection, (G) head of pancreas mass (white arrow) in a patient that underwent a fine needle biopsy and received a subsequent diagnosis of autoimmune pancreatitis.

Figure 3

Proposed algorithm for the role of ERCP and EUS in the management of paediatric chronic pancreatitis. CBD, common bile duct; EHL, electro-hydraulic lithotripsy; ERCP, endoscopic retrograde cholangio-pancreatogram; EUS, endoscopic ultrasound; FNA, fine needle aspiration; FNB fine needle biopsy; HPB MDT, hepato-pancreato-biliary multi-disciplinary team; MRI, magnetic resonance imaging; MRCP, magnetic resonance cholangio-pancreatogram; PEI, pancreatic exocrine insufficiency; PD, pancreatic duct. * Other pancreatic anatomical variants include annular pancreas.