Endoscopic pancreatic interventions in children

   Aim. To increase the efficiency of surgical treatment for children with pancreatic malformations and diseases using endoscopic interventions.

   Materials and methods. The study enrolled 39 children aged 3–17 years who underwent 58 endoscopic interventions.

   Results. Transpapillary interventions were performed in 14 children with pancreatic duct abnormalities. Stenosis of the proximal pancreatic ducts was revealed in 5 observations – stenting was performed. Lithiasis of Wirsung's duct was confirmed in 4 observations, an abnormality in the form of an incomplete pancreas divisum was revealed in 3 of them. Pancreas divisum was detected in 1 patient, sphincterotomy of the minor duodenal papilla was performed. Transmural interventions were carried out in 24 observations: puncture – in 10 patients with intra- or parapancreatic cystic formations, drainage – in 14 patients with pseudocysts. Combined transpapillary and transmural surgery was performed in a child with traumatic pancreatic disruption.

   Conclusion. Transpapillary interventions prove to effectively eliminate hypertension in the pancreatic ducts in children. Transmural procedures can be used to drain pancreatic pseudocysts in children.

1. Kumar S., Ooi C.Y., Werlin S., Abu-El-Haija M., Barth B., Bellin M.D., Durie P.R., Fishman D.S., Freedman S.D., Gariepy C., Giefer M.J., Gonska T., Heyman M.B., Himes R., Husain S.Z., Lin T.K., Lowe M.E., Morinville V., Palermo J.J., Pohl J.F., Schwarzenberg S.J., Troendle D., Wilschanski M., Zimmerman M.B., Uc A. Risk factors associated with pediatric acute recurrent and chronic pancreatitis: lessons from INSPPIRE. JAMA Pediatr. 2016; 170 (6): 562–569. doi: 10.1001/jamapediatrics.2015.4955

2. Liu Q.Y., Gugig R., Troendle D.M., Bitton S., Patel N., Vitale D.S., Abu-El-Haija M., Husain S.Z., Morinville V.D. The Roles of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the evaluation and treatment of chronic pancreatitis in children: a position paper from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J. Pediatr. Gastroenterol. Nutr. 2020; 70 (5): 681–693. doi: 10.1097/MPG.0000000000002664

3. Solodinina E.N., Sokolov Y.Y., Efremenkov A.M., Fomicheva N.V., Zykin A.P., Utkina T.V. Endosonography of the pancreatobiliary area in pediatric patients. The first experience. Russian Journal of Pediatric Surgery. 2021; 25 (6): 368–374. doi: 10.55308/1560-9510-2021-25-6-368-374 (In Russian)

4. Oracz G., Pertkiewicz J., Kierkus J., Dadalski M., Socha J., Ryzko J. Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis. Gastrointest. Endosc. 2014; 80 (6): 1022–1029. doi: 10.1016/j.gie.2014.04.001

5. Li Z.S., Wang W., Liao Z., Zou D.W., Jin Z.D., Chen J., Wu R.P., Liu F., Wang L.W., Shi X.G., Yang Z., Wang L. A long-term follow-up study on endoscopic management of children and adolescents with chronic pancreatitis. Am. J. Gastroenterol. 2010; 105 (8): 1884–1892. doi: 10.1038/ajg.2010.85

6. Lightdale J.R., Acosta R., Shergill A.K., Chandrasekhara V., Chathadi K., Early D., Evans J.A., Fanelli R.D., Fisher D.A., Fonkalsrud L., Hwang J.H., Kashab M., Muthusamy V.R., Pasha S., Saltzman J.R., Cash B.D.; American Society for Gastrointestinal Endoscopy. Modifications in endoscopic practice for pediatric patients. Gastrointest. Endosc. 2014; 79 (5): 699–710. doi: 10.1016/j.gie.2013.08.014

7. Galperin E.I., Chevokin A.Yu., Dyuzheva T.G. Features of symptomatology and surgical treatment of various types of cicatricial biliary strictures. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017; 22 (3): 19–28. doi: 10.16931/1995-5464.2017319-28 (In Russian)

8. Tringali A., Thomson M., Dumonceau J.M., Tavares M., Tabbers M.M., Furlano R., Spaander M., Hassan C., Tzvinikos C., Ijsselstijn H., Viala J., Dall'Oglio L., Benninga M., Orel R., Vandenplas Y., Keil R., Romano C., Brownstone E., Hlava Š., Gerner P., Dolak W., Landi R., Huber W.D., Everett S., Vecsei A., Aabakken L., Amil-Dias J., Zambelli A. Pediatric gastrointestinalendoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline executive summary. Endoscopy. 2017; 49 (1): 83–91. doi: 10.1055/s-0042-111002

9. Abu-El-Haija M., Kumar S., Quiros J.A., Balakrishnan K., Barth B., Bitton S., Eisses J.F., Foglio E.J., Fox V., Francis D., Freeman A.J., Gonska T., Grover A.S., Husain S.Z., Kumar R., Lapsia S., Lin T., Liu Q.Y., Maqbool A., Sellers Z.M., Szabo F., Uc A., Werlin S.L., Morinville V.D. Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J. Pediatr. Gastroenterol. Nutr. 2018; 66 (1): 159–176. doi: 10.1097/MPG.0000000000001715

10. Nabi Z., Lakhtakia S., Basha J., Chavan R., Gupta R., Ramchandani M., Kalapala R., Pal P., Darisetty S., Rao G.V., Nageshwar Reddy D. Endoscopic drainage of pancreatic fluid collections: long-term outcomes in children. Dig. Endosc. 2017; 29 (7): 790–797. doi: 10.1111/den.12884

11. Troendle D.M., Fishman D.S., Barth B.A., Giefer M.J., Lin T.K., Liu Q.Y., Abu-El-Haija M., Bellin M.D., Durie P.R., Freedman S.D., Gariepy C., Gonska T., Heyman M.B., Himes R., Husain S.Z., Kumar S., Lowe M.E., Morinville V.D., Ooi C.Y., Palermo J., Pohl J.F., Schwarzenberg S.J., Werlin S., Wilschanski M., Zimmerman M.B., Uc A. Therapeutic endoscopic retrograde cholangiopancreatography in pediatric patients with acute recurrent and chronic pancreatitis: data from the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) Study. Pancreas. 2017; 46 (6): 764–769. doi: 10.1097/MPA.0000000000000848

12. Еnestvedt B.K., Tofani C., Lee D.Y., Abraham M., Shah P., Chandrasekhara V., Ginsberg G.G., Long W., Ahmad N., Jaffe D.L., Mamula P., Kochman M.L. Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious. J. Pediatr. Gastroenterol. Nutr. 2013; 57 (5): 649–654. doi: 10.1097/MPG.0b013e31829e0bb6

13. Iqbal C.W., Baron T.H., Moir C.R., Ishitani M.B. Post-ERCP pancreatitis in pediatric patients. J. Pediatr. Gastroenterol. Nutr. 2009; 49 (5): 430–434. doi: 10.1097/01.mpg.0000361657.54810.19

14. Dumonceau J.M., Delhaye M., Tringali A., Arvanitakis M., Sanchez-Yague A., Vaysse T., Aithal G.P., Anderloni A., Bruno M., Cantú P., Devière J., Domínguez-Muñoz J.E., Lekkerkerker S., Poley J.W., Ramchandani M., Reddy N., van Hooft J.E. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018. Endoscopy. 2019; 51 (2): 179–193. doi: 10.1055/a-0822-0832

15. Ang T.L., Teoh A.Y.B. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig. Endosc. 2017; 29 (4): 463–471. doi: 10.1111/den.12797

16. Starkov Yu.G., Zamolodchikov R.D., Dzhantukhanova S.V., Vyborniy M.I., Lukich K.V., Ibragimov A.S., Goncharov I.M., Lavrentyeva V.Yu. The results of endosonography-assisted internal drainage of pancreatic pseudocyst. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019; 24 (1): 43–52. doi: 10.16931/1995-5464.2019143-52 (In Russian)

17. Durleshter V.M., Genrikh S.R., Makarenko A.V., Kirakosyan D.S. Current treatment of pancreatic pseudocysts : a systematic review. Kuban Scientific Medical Bulletin. 2021; 28 (4): 85–99. doi: 10.25207/1608-6228-2021-28-4-85-99 (In Russian)

18. Watanabe Y., Mikata R., Yasui S., Ohyama H., Sugiyama H., Sakai Y., Tsuyuguchi T., Kato N. Short- and long-term results of endoscopic ultrasound-guided transmural drainage for pancreatic pseudocysts and walled-off necrosis. World J. Gastroenterol. 2017; 23 (39): 7110–7118. doi: 10.3748/wjg.v23.i39.7110

19. Ramesh J., Bang J.Y., Trevino J., Varadarajulu S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J. Pediatr. Gastroenterol. Nutr. 2013; 56 (1): 30–35. doi: 10.1097/MPG.0b013e318267c113

20. Raina A., Conrad M.A., Sahn B., Sedarat A., Ginsberg G.G., Ahmad N.A., Chandrasekhara V., Mamula P., Kochman M.L. Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population. Endosc. Ultrasound. 2017; 6 (3): 195–200. doi: 10.4103/eus.eus_2_17

21. Kozlov Iu.A., Neustroev V.G., Latypov V.Kh., Novozhilov V.A., Veber I.N., Rasputin A.A., Kovalkov K.A., Chubko D.M., Baradieva P.J., Zvonkov D.A., Timofeev A.D., Ochirov Ch.B., Rasputina N.V., Us G.P, Kuznetsova N.N., Kononenko M.I. Endoscopic drainage of pancreatic pseudocysts under ultrasound guidance in children. Endoscopic Surgery. 2018; 24 (4): 57–60. doi: 10.17116/endoskop20182404157 (In Russian)

22. Solodinina E.N., Efremenkov A.M., Fomicheva N.V., Sokolov Y.Y., Zykin A.P. Therapeutic pancreaticobiliary endoscopy in children: case series. Russian Journal of Evidence-Based Gastroenterology. 2022; 11 (3): 44–51. doi: 10.17116/dokgastro20221103144 (In Russian)