Endoscopic Methods Appear Safe in Pediatric Chronic Pancreatitis

Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) can safely diagnose chronic pancreatitis (CP) and assist in the management of complications related to chronic pancreatitis among pediatric patients, according to a new position paper from the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Pancreas Committee.

To reach this conclusion, the authors conducted a literature review of publications that highlighted the use of ERCP and EUS in the diagnosis and/or management of CP. The researchers focused on studies that included participants aged 18 years or younger to develop their recommendations.

Based on the review, the authors determined that EUS or ERCP can be used even in small children to assist in the diagnosis of CP when cross-sectional imaging is not sufficient to diagnose or characterize the disease.

The review also showed that both modalities can be used for the management of CP-related fluid collections, and that ERCP has successfully been used to manage pancreatic duct stones.

According to the study authors, the procedure-related risks among pediatric and adult patients are similar, with EUS having a safer risk profile overall. Because EUS has lower complication rates than ERCP, the authors deemed EUS as the preferred diagnostic modality.

Because EUS in children under 15 kg and ERCP in children under 10 kg is technically challenging, appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children should be the clinicians to optimally perform the procedures, the authors wrote.

“The recent increase in pediatric-trained specialists will improve access of these modalities for children,” the paper’s authors concluded.

—Colleen Murphy

Reference:

Liu QY, Gugig R, Troendle DM, et al. The roles of EUS and ERCP in the evaluation and treatment of chronic pancreatitis in children: a position paper from the NASPGHAN Pancreas Committee [published online February 19, 2020]. J Pediatr Gastroenterol Nutr. doi:10.1097/MPG.0000000000002664