Skip to main content

Advertisement

SpringerLink
Log in

Pancreatobiliary Endoscopic Interventions for Pediatric Pancreatic Pathology

  • INVITED REVIEW
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Endoscopic ultrasound

FNA:

Fine-needle aspiration

AP:

Acute pancreatitis

AIP:

Autoimmune pancreatitis

CP:

Chronic pancreatitis

ARP:

Acute recurrent pancreatitis

PFC:

Pancreatic fluid collections

WOPN:

Walled-off pancreatic necrosis

PBM:

Pancreaticobiliary maljunction

CPN:

Celiac axis neurolysis

References

  1. Nydegger A, Heine RG, Ranuh R, et al. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children’s Hospital Melbourne. J Gastroenterol Hepatol. 2007;22:1313e6.

    Google Scholar 

  2. Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas. 2010;39:5–8.

    PubMed  Google Scholar 

  3. Poddar U, Yachha SK, Borkar V, Srivastava A, Kumar S. A report of 320 cases of childhood pancreatitis: increasing incidence, etiologic categorization, dynamics, severity assessment and outcome. Pancreas. 2017;46:110–115.

    PubMed  Google Scholar 

  4. Aliye UC, Yen EH, Wilschanski M, et al. Pediatric acute recurrent and chronic pancreatitis: report from INSPPIRE consortium. Gastroenterology. 2014;146:1–4.

    Google Scholar 

  5. Lightdale JR, Acosta R, et al. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2014;79:699–710.

    PubMed  Google Scholar 

  6. Thomson M, Tringali A, Dumonceau JM, et al. Paediatric gastrointestinal endoscopy. European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. J Pediatr Gastroenterol Nutr. 2017;64:133–153.

    PubMed  Google Scholar 

  7. Tierney WM, Adler DG, Chand B, et al. Echoendoscopes. Gastrointest Endosc. 2007;66:435–442.

    PubMed  Google Scholar 

  8. Kouchi K, Yoshida H, Matsunaga T, et al. Endosonographic evaluation in two children with esophageal stenosis. J Pediatr Surg. 2002;37:934–936.

    PubMed  Google Scholar 

  9. Khoshoo V, Thoppil D, Landry L, et al. Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr. 2003;37:146–149.

    CAS  PubMed  Google Scholar 

  10. Kaddu R, Bhattacharya D, Metriyakool K, et al. Propofol compared with general anesthesia for pediatric GI endoscopy: is propofol better? Gastrointest Endosc. 2002;55:27–32.

    PubMed  Google Scholar 

  11. Lee KK, Anderson MA, Baron TH, et al. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2008;67:1–9.

    PubMed  Google Scholar 

  12. Graham KS, Ingram JD, Steinberg SE, Narkewicz MR. ERCP in the management of pediatric pancreatitis. Gastrointest Endosc. 1998;47:492–495.

    CAS  PubMed  Google Scholar 

  13. Poddar U, Thapa BR, Bhasin DK, et al. Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol. 2001;16:927–931.

    CAS  PubMed  Google Scholar 

  14. Cheng CL, Fogel EL, Sherman S, et al. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report. J Pediatr Gastroenterol Nutr. 2005;41:445–453.

    PubMed  Google Scholar 

  15. Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children. World J Gastroenterol. 2010;16:490–495.

    PubMed  PubMed Central  Google Scholar 

  16. Otto AK, Neal MD, Slivka AN, et al. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases. Surg Endosc. 2011;25:2536–2540.

    PubMed  Google Scholar 

  17. Limketkai BN, Chandrasekhara V, Kalloo AN, Okolo PI 3rd. Comparison of performance and safety of endoscopic retrograde cholangiopancreatography across pediatric age groups. Dig Dis Sci. 2013;58:2653–2660.

    PubMed  Google Scholar 

  18. Giefer MJ, Kozarek RA. Technical outcomes and complications of pediatric ERCP. Surg Endosc. 2015;29:3543–3550.

    PubMed  Google Scholar 

  19. Troendle DM, Fishman DS, Barth BA, et al. Therapeutic endoscopic retrograde cholangiopancreatography in pediatric patients with acute recurrent and chronic pancreatitis: data from the INSPPIRE (International Study group of Pediatric Pancreatitis: In search for a cuRE) Study. Pancreas. 2017;46:764–769.

    PubMed  PubMed Central  Google Scholar 

  20. Agarwal J, Reddy DN, Talukdar R, et al. ERCP in the management of pancreatic diseases in children. Gastrointest Endosc. 2014;79:271–278.

    PubMed  Google Scholar 

  21. Oracz G, Pertkiewicz J, Kierkus J, et al. Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis. Gastrointest Endosc. 2014;80:1022–1069.

    PubMed  Google Scholar 

  22. Li ZS, Wang W, Liao Z, et al. A long-term follow-up study on endoscopic management of children and adolescents with chronic pancreatitis. Am J Gastroenterol. 2010;105:1884–1892.

    PubMed  Google Scholar 

  23. Hsu RK, Draganov P, Leung JW, et al. Therapeutic ERCP in the management of pancreatitis in children. Gastrointest Endosc. 2000;51:396–400.

    CAS  PubMed  Google Scholar 

  24. Kohoutova D, Tringali A, Papparella G, et al. Endoscopic treatment of chronic pancreatitis in pediatric population: Long-term efficacy and safety. United Eur Gastroenterol J. 2019;7:270–277.

    CAS  Google Scholar 

  25. Wang D, Bi YW, Ji JT, et al. Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis. Endoscopy. 2017;49:447–455.

    PubMed  PubMed Central  Google Scholar 

  26. Cahen DL, Gouma DJ, Laramée P, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology. 2011;141:1690–1695.

    PubMed  Google Scholar 

  27. Wen J, Li T, Liu L, Bie LK, Gong B. Long-term outcomes of therapeutic ERCP in pediatric patients with pancreas divisum presenting with acute recurrent or chronic pancreatitis. Pancreatology. 2019;19:834–841.

    PubMed  Google Scholar 

  28. Troendle DM, Barth BA. ERCP can be safely and effectively performed by a pediatric gastroenterologist for choledocholithiasis in a pediatric facility. J Pediatr Gastroenterol Nutr.. 2013;57:655–658.

    PubMed  Google Scholar 

  29. Fishman DS, Chumpitazi BP, Raijman I, et al. Endoscopic retrograde cholangiography for pediatric choledocholithiasis: assessing the need for endoscopic intervention. World J Gastrointest Endosc.. 2016;8:425–432.

    PubMed  PubMed Central  Google Scholar 

  30. Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev. 2012;5:CD009779.

    Google Scholar 

  31. Uhl W, Warshaw A, Imrie C, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2:565–573.

    PubMed  Google Scholar 

  32. De Angelis P, Foschia F, Romeo E, et al. Role of endoscopic retrograde cholangiopancreatography in diagnosis and management of congenital choledochal cysts: 28 pediatric cases. J Pediatr Surg. 2012;47:885–888. https://doi.org/10.1016/j.jpedsurg.2012.01.040.

    Article  PubMed  Google Scholar 

  33. Zeng JQ, Deng ZH, Yang KH, et al. Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: a retrospective multicenter study. World J Gastroenterol. 2019;25:6107–6115. https://doi.org/10.3748/wjg.v25.i40.6107.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Garvey EM, Haakinson DJ, McOmber M, Notrica DM. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015;50:335–338.

    PubMed  Google Scholar 

  35. Houben CH, Ade-Ajayi N, Patel S, et al. Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg. 2007;42:629–635. https://doi.org/10.1016/j.jpedsurg.2006.12.025.

    Article  PubMed  Google Scholar 

  36. Rosenfeld EH, Vogel AM, Klinkner DB, et al. The utility of ERCP in pediatric pancreatic trauma. J Pediatr Surg. 2017;53:146–151. https://doi.org/10.1016/j.jpedsurg.2017.10.038.

    Article  Google Scholar 

  37. Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842–848.

    CAS  PubMed  Google Scholar 

  38. Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP. Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc. 1995;42:208–213.

    CAS  PubMed  Google Scholar 

  39. Sharma SS, Maharshi S. Endoscopic management of pancreatic pseudocyst in children: a long-term follow-up. J Pediatr Surg. 2008;43:1636–1639.

    PubMed  Google Scholar 

  40. Makin E, Harrison PM, Patel S, Davenport M. Pancreatic pseudocysts in children: treatment by endoscopic cyst gastrostomy. J Pediatr Gastroenterol Nutr. 2012;55:556–558.

    PubMed  Google Scholar 

  41. Usatin D, Fernandes M, Allen IE, Perito ER, Ostroff J, Heyman MB. Complications of endoscopic retrograde cholangiopancreatography in pediatric patients; a systematic literature review and meta-analysis. J Pediatr. 2016;179:160–165.

    PubMed  PubMed Central  Google Scholar 

  42. Troendle DM, Abraham O, Huang R, Barth BA. Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population. Gastrointest Endosc. 2015;81:1408–1416.

    PubMed  Google Scholar 

  43. Varadarajulu S, Wilcox CM, Eloubeidi MA. Impact of EUS in the evaluation of pancreaticobiliary disorders in children. Gastrointest Endosc. 2005;62:239–244.

    PubMed  Google Scholar 

  44. Attila T, Adler DG, Hilden K, et al. EUS in pediatric patients. Gastrointest Endosc. 2009;70:892–898.

    PubMed  Google Scholar 

  45. Cohen S, Kalinin M, Yaron A, et al. Endoscopic ultrasonography in pediatric patients with gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2008;46:551–554.

    PubMed  Google Scholar 

  46. Al-Rashdan A, LeBlanc J, Sherman S, et al. Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: a tertiary care center experience. J Pediatr Gastroenterol Nutr. 2010;51:718–722.

    PubMed  Google Scholar 

  47. Keane MG, Kumar M, Cieplik N, et al. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr. 2018;18:42.

    PubMed  PubMed Central  Google Scholar 

  48. Kahl S, Glasbrenner B, Leodolter A, et al. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55:507–511.

    PubMed  Google Scholar 

  49. Pungpapong S, Wallace MB, Woodward TA, et al. Accuracy of endoscopic ultrasonography and magnetic resonance cholangiopancreatography for the diagnosis of chronic pancreatitis: a prospective comparison study. J Clin Gastroenterol. 2007;41:88–93.

    PubMed  Google Scholar 

  50. Gardner TB, Levy MJ. EUS diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71:1280–1289.

    PubMed  Google Scholar 

  51. Stevens T, Lopez R, Adler DG, et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71:519–526.

    PubMed  Google Scholar 

  52. Petrone MC, Arcidiacono PG, Testoni PA. Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis. World J Gastroenterol. 2008;14:1016–1022.

    PubMed  PubMed Central  Google Scholar 

  53. Singh SK, Srivastava A, Rai P, Yachha SK, Poddar U. Yield of endoscopic ultrasound in children and adolescent with acute recurrent pancreatitis. JPGN. 2018;66:461–465.

    PubMed  Google Scholar 

  54. Mahajan R, Simon EG, Chacko A, et al. Endoscopic ultrasonography in pediatric patients—experience from a tertiary care center in India. Indian J Gastroenterol. 2016;35:14–19.

    PubMed  Google Scholar 

  55. Scheers I, Palermo JJ, Freedman S, et al. Recommendations for diagnosis and management of autoimmune pancreatitis in childhood: consensus from INSPPIRE. J Pediatr Gastroenterol Nutr. 2018;67:232–236.

    PubMed  PubMed Central  Google Scholar 

  56. Fujii LL, Chari ST, El-Youssef M, et al. Pediatric pancreatic EUS-guided Trucut biopsy for evaluation of autoimmune pancreatitis. Gastrointest Endosc. 2013;77:824–828.

    PubMed  Google Scholar 

  57. Scheers I, Ergun M, Aouattah T, et al. The diagnostic and therapeutic role of endoscopic ultrasound in pediatric pancreaticobiliary disorders. J Pediatr Gastroenterol Nutr. 2015;16:238–247.

    Google Scholar 

  58. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.

    PubMed  Google Scholar 

  59. Lakhtakia S, Agarwal J, Gupta R, Ramchandani M, Rakesh K, Nageshwar Reddy D. EUS-guided transesophageal drainage of peripancreatic fluid collections in children. Gastrointest Endosc. 2015;82:587–588.

    PubMed  Google Scholar 

  60. Jazrawi Saad F, Barth Bradley A, Sreenarasimhaiah Jayaprakash. Efficacy of Endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci. 2011;56:902–908.

    PubMed  Google Scholar 

  61. Nabi Z, Lakhtakia S, Basha J, et al. Endoscopic drainage of pancreatic fluid collections: long-term outcomes in children. Dig Endosc. 2017;29:790–797.

    PubMed  Google Scholar 

  62. Ramesh J, Bang JY, Trevino J, Varadarajulu S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J Pediatr Gastroenterol Nutr. 2013;56:30–35.

    PubMed  Google Scholar 

  63. Siddiqui AA, Adler DG, Nieto J, et al. EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter US experience (with videos). Gastrointest Endosc. 2016;83:699–707.

    PubMed  Google Scholar 

  64. Nabi Z, Lakhtakia S, Basha J, et al. Endoscopic ultrasound guided drainage of walled-off necrosis in children with fully covered self-expanding metal stents. J Pediatr Gastroenterol Nutr. 2017;64:592–597.

    PubMed  Google Scholar 

  65. Trikudanathan G, Arain M, Mallery S, Freeman M, Attam R. Endoscopic necrosectomy in children. J Pediatr Gastroenterol Nutr. 2014;59:270–273.

    PubMed  Google Scholar 

  66. Giefer MJ, Balmadrid BL. Pediatric application of the lumen-apposing metal stent for pancreatic fluid collections. Gastrointest Endosc. 2016;84:188–189.

    PubMed  Google Scholar 

  67. Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127–134.

    PubMed  Google Scholar 

  68. Early DS, Acosta RD, Chandrasekhara V, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc. 2013;77:839–843.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Regency Health, Kanpur, India

    Jaya Agarwal

Authors
  1. Jaya Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaya Agarwal.

Ethics declarations

Conflict of interest

The author declares that there is no conflict of interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, J. Pancreatobiliary Endoscopic Interventions for Pediatric Pancreatic Pathology. Dig Dis Sci 65, 3091–3101 (2020). https://doi.org/10.1007/s10620-020-06513-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06513-x

Keywords

Search

Navigation