THE ROLE OF ERCP IN THE DIAGNOSIS AND TREATMENT OF IDIOPATHIC RECURRENT PANCREATITIS IN CHILDREN AND ADOLESCENTS

ERCP was performed in 51 patients, aged 1 to 18 years, as part of diag nostic evaluation for recurrent pancreatitis without obvious cause or as therapeutic intervention. ERCP was successful in 50 patients (98%). Thirty-four patients (68%) had anatomic findings indicating a possibl e cause of recurrent pancreatitis. Three patients (6%) had findings su ggestive of sphincter of Oddi dysfunction. Eighteen of the 37 patients (49%) with ductal abnormalities underwent endoscopic therapy, with a favorable outcome in 15 (83%). Eleven patients were treated surgically , and 8 of these patients (73%) improved symptomatically. Eight patien ts received no treatment, and 6 of them (67%) had recurrent bouts of c linical pancreatitis. One mild case of pancreatitis (1.9%) occurred af ter ERCP, and 3 mild cases followed endoscopic therapy. In conclusion, ERCP is a relatively safe technique that produces opacification of th e desired ductal system with a high degree of accuracy and provides us eful information in the evaluation of children with idiopathic recurre nt pancreatitis. These data suggest that endoscopic pancreatic therapy may result in symptomatic improvement, eliminating the need for surge ry in selected children. Furthermore, the study demonstrates that mani pulation of the pancreatic duct is comparatively safe and less hazardo us than formerly believed.