Endotherapy in pediatric pancreatitis

Abstract

Purpose of review Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research. Recent findings Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection. Summary Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.

Case Report: Chronic pancreatitis in children as the cumulative effect of bilio-pancreatic abnormalities and genetic mutations

“…In adult patients with duct stones that are equal to or greater than 5 mm, extracorporeal shockwave lithotripsy (ESWL) and pancreatoscopy are considered as alternative endotherapy approaches ( 22 ). In a series of 72 children, ESWL determined complete pain resolution in 77% of cases.…”

“…In a series of 72 children, ESWL determined complete pain resolution in 77% of cases. Pancreatoscopy with intraductal electrohydraulic lithotripsy is preferred in cases of radiolucent stones ( 22 ).…”

“…Endoscopic ultrasound (EUS) is a diagnostic approach that images the pancreatic parenchyma, ductal anatomy, biliary risk factors, and congenital anomalies ( 29 , 30 ). EUS-guided therapy is also possible for draining pancreatic collections or in cases of necrosis ( 22 ). The success rate ranges from 95 to 100%, but the pooled major adverse event rate is high (6%) ( 31 ).…”

Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series

“…In children, the role of endoscopic approach is still debated because of the limited data about safety and efficacy in this specific population [ 3 , 4 , 15 , 16 , 17 ] and caution should be exercised when extrapolating this approach to pediatric setting, as acute pancreatitis in children has different etiologies, clinical and radiological presentation compared with adults [ 18 ].…”