Therapeutic ERCP in the management of pancreatitis in children

Background: The use of diagnostic and therapeutic endoscopic retrograde cho langiopancreatography (ERCP) is increasing in the management of pancreatobi liary diseases in children. Methods: Over a 32-month period, we performed 34 ERCP procedures for the tr eatment of pancreatitis in 22 children at two university hospitals. Demogra phics and clinical data and ERCP findings were documented, Clinical status was assessed 6 months before the first ERCP and 6 months after the last ERC P, according to general condition, severity and frequency of pain, and heal th care encounters (emergency department visits, clinic visits, and hospita l admissions related to the pancreatitis). Results: Mean age of the patients was 10.7 years (range 1.5 to 17 years). A bdominal pain was the main presenting symptoms with hyperamylasemia and hyp erlipasemia, Clinical diagnoses included acute pancreatitis (6), recurrent pancreatitis (5), and chronic pancreatitis (11). The mean followup was 16.4 months. Nine patients had sphincter manometry, with abnormal results leadi ng 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 reductio n in frequency (p < 0.01) and severity of pain (p < 0.01) after interventio n, Patients without pancreatographic changes of chronic pancreatitis had th e most marked clinical improvement (p < 0.05). In those with ductal changes of chronic pancreatitis, clinical improvement was not predicted by the ext ent of ductal changes. There was a significant decrease in health care enco unters (p < 0.05) and improvement in general condition (p < 0.01) after end oscopic therapy, especially in those with a normal pancreatogram. Conclusions: Therapeutic ERCP is safe in pediatric patients with pancreatit is. Significant clinical improvement is achieved in patients with biliary o r pancreatic stone disease. Prospective studies with long-term follow-up ar e needed to determine the impact of endoscopic therapy in patients with chr onic pancreatitis and sphincter of Oddi dysfunction.