3712 ENDOTHERAPY FOR CHRONIC PANCREATITIS IN CHILDHOOD.

Abstract

Background. Chronic pancreatitis (CP) may be responsible for pain and vomiting in children. Endotherapy (ET) including ESWL of severe CP with ductal obstruction has shown to be effective and safe in adults. Few data are available for children. Aim. To review immediate and medium-term results of ET for severe CP in children. Patients and Method. 18 children who underwent therapeutic ERCP for symptomatic CP (Jan 91 - Apr 99) were divided in 2 groups according to their age: children (C) (n=8, males n=2, hereditary/idiopathic 4/4, mean age at onset of disease 3.1y, range 1.5- 5.7y, mean age at ET 5y, range 2.4-6.7y) and teenagers (T) (n=10, males n=6, hereditary/idiopathic 0/10, mean age at onset of disease 10y, range 6- 13, mean age at ET 12y, range 9-14). All patients were European, except 2 teenagers from India. ERCP was always performed under general anesthesia in the supine position. The following Olympus duodenoscopes were used: PJF 7.5 (<3y), JF100 (3-4y), and TJF100-140 (>4y). ERCP findings: normal bile ducts 18/18; dilated MPD 18/18, calcified calculi 5/18, MPD stricture 9/18, dominant dorsal duct 4/18. Results were considered: a) “excellent” when no further pain occurred, b) “good” when pain decreased in frequency and intensity but ET was repeated for relapsing symptoms, c) “fair” when immediate results were good but the patient eventually underwent further surgery. Results. The following procedures were performed in the two groups (C-T), respectively: biliary sphincterotomy 8/8-9/10, pancreatic sphincterotomy (PS) of major papilla 8/8-9/10, PS of minor papilla 4/8-1/10, ESWL 2/8-0/10, stones/plugs extraction 8/8-8/10, pancreatic stenting 3/8-1/10. Stents were exchanged in case of pain. ET was technically successful in all patients except one receiving a stent after failure of stones extraction. There were no complications, nor mortality. Follow-up averaged 5.9y (range 4.2-8.5y) in group C and results were “excellent” (n=3) or “good” (n=5). Follow-up averaged 3y (range 0.5-8y) in group T and results were “excellent” (n=8), “good” (n=1) or “fair” (n=1), this last girl undergoing further pancreatico-jejunostomy. Conclusions. ET of severe CP in children and teenagers is effective and safe, providing prolonged relief from symptoms. ET may significantly delay or even avoid surgery. Background. Chronic pancreatitis (CP) may be responsible for pain and vomiting in children. Endotherapy (ET) including ESWL of severe CP with ductal obstruction has shown to be effective and safe in adults. Few data are available for children. Aim. To review immediate and medium-term results of ET for severe CP in children. Patients and Method. 18 children who underwent therapeutic ERCP for symptomatic CP (Jan 91 - Apr 99) were divided in 2 groups according to their age: children (C) (n=8, males n=2, hereditary/idiopathic 4/4, mean age at onset of disease 3.1y, range 1.5- 5.7y, mean age at ET 5y, range 2.4-6.7y) and teenagers (T) (n=10, males n=6, hereditary/idiopathic 0/10, mean age at onset of disease 10y, range 6- 13, mean age at ET 12y, range 9-14). All patients were European, except 2 teenagers from India. ERCP was always performed under general anesthesia in the supine position. The following Olympus duodenoscopes were used: PJF 7.5 (<3y), JF100 (3-4y), and TJF100-140 (>4y). ERCP findings: normal bile ducts 18/18; dilated MPD 18/18, calcified calculi 5/18, MPD stricture 9/18, dominant dorsal duct 4/18. Results were considered: a) “excellent” when no further pain occurred, b) “good” when pain decreased in frequency and intensity but ET was repeated for relapsing symptoms, c) “fair” when immediate results were good but the patient eventually underwent further surgery. Results. The following procedures were performed in the two groups (C-T), respectively: biliary sphincterotomy 8/8-9/10, pancreatic sphincterotomy (PS) of major papilla 8/8-9/10, PS of minor papilla 4/8-1/10, ESWL 2/8-0/10, stones/plugs extraction 8/8-8/10, pancreatic stenting 3/8-1/10. Stents were exchanged in case of pain. ET was technically successful in all patients except one receiving a stent after failure of stones extraction. There were no complications, nor mortality. Follow-up averaged 5.9y (range 4.2-8.5y) in group C and results were “excellent” (n=3) or “good” (n=5). Follow-up averaged 3y (range 0.5-8y) in group T and results were “excellent” (n=8), “good” (n=1) or “fair” (n=1), this last girl undergoing further pancreatico-jejunostomy. Conclusions. ET of severe CP in children and teenagers is effective and safe, providing prolonged relief from symptoms. ET may significantly delay or even avoid surgery.