ABSTRACTS: Oral Presentation Abstracts
Introduction: Role of ERCP as a diagnostic and therapeutic modality in pancreatitis is gaining wider application. Our aim was to determine the role of ERCP in the management of pancreatitis in children (age <16 yrs) presenting to a tertiary health care centre in North India.
Methods: 65 children (<16 yrs) presenting to the pediatric medical services of the hospital with pancreatitis were recruited in the study from Oct. 1998 to Nov. 2003. Out of 65 patients, 24 were diagnosed as chronic pancreatitis, 27 as acute pancreatitis and 14 as recurrent pancreatitis. ERCP was done in 26(40%) patients, 17 cases were of chronic pancreatitis (70.8%), 5 (18.5%) & 4 (28.5%) cases of acute & recurrent pancreatitis respectively. The mean age of ERCP patients was 11 yrs (range 4yrs – 15 yrs) with male: female ratio of 14:12. In all cases indications, ERCP findings, complications, patients course and therapeutic intervention (if any) were recorded. The procedure was carried under midazolam and ketamine sedation.
Results: Successful cannulation was possible in all cases. Of the 17 patients with chronic pancreatitis ERCP revealed abnormal pancreatic duct in all in the form of duct irregularity/ blunting of secondary branches/ dilatation/ tortousity with stricture in 6 cases (25%). Pancreatic stents were placed in 12 (50%), 6 in stricture cases & 6 in cases with multiple pancreatic duct calculi till the stone clearance was done. Associated CBD stones were seen in 2 cases, which were removed. There was one case each of pancreatic divisum and communicating pseudocyst (stent placed). In the 5 cases with acute pancreatitis ERCP revealed bulge of pseudocyst in stomach in 4 cases, two of which had associated pancreatic duct cut off in body region and CBD stone in one which was removed. Successful endoscopic cystogastrostomy was done in all 4 cases of pseudocyst.This procedure was preceded by a CT scan or Endo ultrasound to assess the suitability of the case. Of the 4 patients with recurrent pancreatitis ERCP revealed normal pancreatic duct in 3 and one had anomalous pancreatico biliary junction (APBJ) type III C3 showing dilated common channel with multiple stones, dilated CBD & dilated but not tortuous pancreatic duct. After papillotomy stones were removed & stenting done. Thus overall ERCP was used as a therapeutic modality in 17 cases (65.3%).
Conclusion: ERCP is a useful modality in the management of both chronic and acute pancreatitis in children. It served as a therapeutic modality in 65% of our patients. Like in adults, endoscopic cystogastrostomy can be safely and effectively performed in children and it must be considered as a management option, by experienced endoscopists.