Journal of pediatric surgery · 2024
Use of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Pediatric Pancreatic Injury.
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Eldredge R Scott, Notrica David M, Patel Mittun, Garvey Erin, Ochoa Brie, McOmber Mark
Аннотация
BACKGROUND: ERCP is the gold standard for evaluating the integrity of the main pancreatic duct (MPD); however, ERCP is underutilized in evaluating MPD integrity in pediatric blunt pediatric injury. The primary aim of this study was to evaluate the discordance of cross-sectional imaging (CSI) and ERCP in children with suspected MPD injury.
METHODS: A retrospective review of all patients age ≤18 years with CSI or clinical findings suggestive of MPD injury (MPDI) and ERCP was conducted at a level I pediatric trauma center from January 2009 to May 2023. Demographic and clinical data were collected. Pancreatic injury findings were compared between cross-sectional imaging and ERCP.
RESULTS: An ERCP was performed in 28 patients with suspected MPDI with a mean age of 7 ± 4.5 years and weight of 25.0 ± 13.6 kg. Based on initial CSI, 23 patients had a suspected MPDI, and 5 had concern for MPDI based on clinical findings. ERCP differed from CSI findings in 39% of patients: 7 with CSI evidence of MPDI without injury on ERCP and 4 patients without imaging concern of MPDI but demonstrated injury on ERCP. Findings on ERCP guided surgical management in 71% (20/28) of patients due to location and completeness of MPDI. All patients without MPDI were managed nonoperatively.
CONCLUSION: Approximately 40% of patients had discordant findings between ERCP and CSI. ERCP can aide in surgical management decision making. All patients with a partial MPDI were managed with endoscopic therapy alone. ERCP should be considered when assessing a child with a suspected MPDI.
LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Diagnostic Study.
METHODS: A retrospective review of all patients age ≤18 years with CSI or clinical findings suggestive of MPD injury (MPDI) and ERCP was conducted at a level I pediatric trauma center from January 2009 to May 2023. Demographic and clinical data were collected. Pancreatic injury findings were compared between cross-sectional imaging and ERCP.
RESULTS: An ERCP was performed in 28 patients with suspected MPDI with a mean age of 7 ± 4.5 years and weight of 25.0 ± 13.6 kg. Based on initial CSI, 23 patients had a suspected MPDI, and 5 had concern for MPDI based on clinical findings. ERCP differed from CSI findings in 39% of patients: 7 with CSI evidence of MPDI without injury on ERCP and 4 patients without imaging concern of MPDI but demonstrated injury on ERCP. Findings on ERCP guided surgical management in 71% (20/28) of patients due to location and completeness of MPDI. All patients without MPDI were managed nonoperatively.
CONCLUSION: Approximately 40% of patients had discordant findings between ERCP and CSI. ERCP can aide in surgical management decision making. All patients with a partial MPDI were managed with endoscopic therapy alone. ERCP should be considered when assessing a child with a suspected MPDI.
LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Diagnostic Study.