ERCP IN THE MANAGEMENT OF PEDIATRIC PANCREATITIS

Background: Although ERCP is commonly performed in children, the effec t of findings at ERCP on the subsequent management of pediatric pancre atitis is unknown. Methods: We retrospectively reviewed charts Po dete rmine the impact of ERCP on the management of recurrent acute or chron ic pancreatitis in 17 consecutive children (3 boys and 14 girls, 3 to 16 years, mean 11.2 years) with recurrent acute (n = 13) or chronic pa ncreatitis (n = 4) who underwent ERCP. Radiographs were reviewed in a blinded manner, and the effect of ERCP findings on subsequent manageme nt was determined. Results: In 16 of 17 patients (94%), the pancreatic duct was successfully visualized. Of the 16 studies, 9 (56%) had abno rmal findings. A change in therapy occurred in all 9 patients as a res ult of the findings at ERCP. Of the 7 patients with a prior abnormal C T or ultrasound, 5 (71%) had an abnormal ERCP, all resulting in a chan ge in therapy. Three of the 9 patients (33%) without radiographic abno rmalities had an abnormal ERCP that, in each case, resulted in a chang e in therapy. Overall, findings at ERCP altered therapy in 52% of pedi atric patients studied with recurrent acute or chronic pancreatitis. A prior abnormal CT had a high predictive value with respect to ERCP re sulting in a change in management (83%). Conclusions: ERCP is useful i n the management of pediatric recurrent acute or chronic pancreatitis; abnormalities are found at a rate similar to those found in adults.