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Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report

Lin, Tom K.*; Troendle, David M.; Wallihan, Daniel B.; Barth, Bradley; Fox, Victor L.§; Fishman, Douglas S.||; Morinville, Veronique D.

Journal of Pediatric Gastroenterology & Nutrition: March 2017 - Volume 64 - Issue 3 - p 472–484
doi: 10.1097/MPG.0000000000001371
Society Papers

Objectives: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed.

Methods: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified.

Results: TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures.

Conclusions: Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.

*Cincinnati Children's Hospital Medical Center, Cincinnati, OH

University of Texas Southwestern Medical School, Dallas, TX

Levine Children's Hospital, Charlotte, NC

§Boston Children's Hospital, Boston, MA

||Baylor College of Medicine, Houston, TX

Montreal Children's Hospital, McGill University, Montreal, QC, Canada.

Address correspondence and reprint requests to Veronique D. Morinville, MDCM, FRCPC, Division of Pediatric Gastroenterology and Nutrition, Montreal Children's Hospital, McGill University Health Centre, B04.2443, 1001 Blvd Decarie, Montreal, QC, Canada H4A 3J1 (e-mail: Veronique.morinville@mcgill.ca).

Received 24 February, 2016

Accepted 2 August, 2016

The concept for this work was supported by NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition).

T.K.L., B.B., V.L.F., and V.D.M. are members of the NASPGHAN Pancreas Committee; D.M.T. and D.S.F. are members of the NASPGHAN Endoscopy and Procedures Committee; T.K.L., D.M.T., B.B., V.L.F., and D.S.F. are members of the NASPGHAN ERCP Special Interest Group.

T.K.L., D.M.T., and D.B.W. are co-first authors.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,