ERCP for pancreatic disease in children
- Moises Guelrud, MD
Moises Guelrud, MD
- Clinical Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- Douglas A Howell, MD, FASGE, FACG
Douglas A Howell, MD, FASGE, FACG
- Section Editor — EUS/ERCP
- Assistant Clinical Professor of Medicine, Tufts Medical School Director,
- Pancreaticobiliary Center Director, Advanced Interventional Endoscopy Fellowship, Maine Medical Center
Endoscopic retrograde cholangiopancreatography (ERCP) has changed the approach to the diagnosis and management of pancreatic disorders in adults. It remains a less common procedure in children despite accumulating experience since the mid-1980s in the use of ERCP for a variety of indications.
The pancreatic disorders that can be evaluated by ERCP are described here. The use of ERCP for biliary disorders in children and the technique, success, and complications of ERCP in children are discussed separately. (See "ERCP for biliary disease in children" and "ERCP in children: Technique, success and complications".)
UNEXPLAINED ACUTE AND RECURRENT PANCREATITIS
Endoscopic retrograde cholangiopancreatography (ERCP) should be considered for all patients with pancreatitis for which an anatomical cause is suspected. Potential indications for ERCP in children with pancreatitis are listed in the table (table 1) .
Initial evaluation — Prior to considering ERCP, specific non-anatomical causes of pancreatitis should be explored. These include infections, systemic diseases (including inflammatory conditions and cystic fibrosis), drug-induced pancreatitis, and blunt trauma to the pancreas. In recurrent or chronic pancreatitis, hereditary causes should be explored through genetic screens for cationic trypsinogen (PRSS1), SPINK 1, cystic fibrosis transmembrane conductance regulator (CFTR) and chymotrypsinogen C (CTRC) mutations . (See "Clinical manifestations and diagnosis of chronic and acute recurrent pancreatitis in children" and "Hereditary pancreatitis", section on 'Genetic testing' and "Causes and contributing risk factors for chronic pancreatitis in children and adolescents", section on 'Genetic'.)
Imaging with abdominal computerized tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) is important to establish the extent of the pancreatitis. Some experts suggest MRCP prior to consideration of ERCP for most patients with chronic or recurrent pancreatitis because ERCP is more invasive and the procedure may trigger or exacerbate the pancreatitis. Others have suggested endoscopic ultrasound (EUS) which is particularly useful for diagnosing gallbladder sludge, pancreas divisum, congenital biliary anomalies, duodenal duplication cyst, and chronic pancreatitis . On the other hand, ERCP has the advantage of offering therapeutic interventions, such as sphincterotomy and stent placement. Therefore, ERCP is appropriate for patients in whom a treatable anatomic anomaly has been identified or is strongly suspected. (See "Clinical manifestations and diagnosis of chronic and acute recurrent pancreatitis in children", section on 'Initial imaging'.)
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- UNEXPLAINED ACUTE AND RECURRENT PANCREATITIS
- Initial evaluation
- Indications for ERCP
- - First attack of pancreatitis
- - Recurrent pancreatitis
- ERCP findings and interventions by cause
- - Congenital anomalies
- Biliary cysts
- Pancreas divisum
- Other pancreatic congenital anomalies
- Duodenal duplication cysts
- - Acquired diseases
- Parasitic infestation
- Sphincter of Oddi dysfunction
- HIV infection
- Autoimmune pancreatitis
- OTHER INDICATIONS FOR ERCP
- Chronic pancreatitis
- - Diagnostic ERCP
- - Therapeutic ERCP
- Pancreatic pseudocysts
- Pancreatic trauma