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Mauer TL, Trocchia C, Collard M, Chandler NM, Poulos N, Wilsey M. Percutaneous-Endoscopic Rendezvous Procedure in a Pediatric Patient With Biliary Obstruction and Altered Anatomy. J Pediatr Gastroenterol Nutr 2023; 77:e67. [PMID: 37229766 DOI: 10.1097/mpg.0000000000003842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Tian L Mauer
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Carolena Trocchia
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Michael Collard
- the Department of Radiology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Nicole M Chandler
- the Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Nicholas Poulos
- AdventHealth Medical Group Pediatric Surgery at Tampa, Tampa, FL
| | - Michael Wilsey
- the Department of Gastroenterology, Nutrition, and Hepatology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
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Norris N, Troendle DM. Endotherapy in pediatric pancreatitis. Curr Opin Gastroenterol 2023:00001574-990000000-00088. [PMID: 37523027 DOI: 10.1097/mog.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research. RECENT FINDINGS Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection. SUMMARY Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.
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Affiliation(s)
- Nicholas Norris
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Children's Health, Dallas, Texas, USA
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Gupta R, Khalaf RT, Morrison J, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Dua K, Werlin S, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative. J Pediatr Gastroenterol Nutr 2023; 77:126-130. [PMID: 36976177 DOI: 10.1097/mpg.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure's success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success ( P = 0.65) or adverse events rates ( P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups ( P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.
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Affiliation(s)
- Rekha Gupta
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Racha T Khalaf
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL
| | - John Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | | | - Wenly Ruan
- Baylor College of Medicine Texas Children's Hospital, Houston, TX
| | - Douglas S Fishman
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, Republic of Korea
| | - Mercedes Martinez
- Columbia University New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Steven Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health; Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Victor L Fox
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
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Hassan AM, Lin TK, Smith MT, Hornung L, Abu-El-Haija M, Nathan JD, Vitale DS. Risk Factors for Post-ERCP Pancreatitis in Pediatric and Young Adult Patients. J Pediatr Gastroenterol Nutr 2023; 76:807-812. [PMID: 36930983 DOI: 10.1097/mpg.0000000000003766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Post-ERCP pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Limited existing data suggest that prophylactic pancreatic duct (PD) stenting in pediatric patients may increase the risk of PEP. The aim of this study is to identify factors associated with PEP in pediatric patients. METHODS Patients at a single institution who underwent ERCP between 2012 and 2020 were retrospectively reviewed. Patient and procedure-related factors were collected. Data were analyzed using Chi-square or Fisher exact tests as appropriate and Mann-Whitney-Wilcoxon tests. RESULTS Seven hundred thirty-six ERCPs were performed for 402 unique patients. Ninety-four cases were complicated by PEP (12.8%), of which 91 were mild and 3 were moderately severe. Pancreatic indication, native major papilla, PD cannulation and injection, and higher American Society for Gastrointestinal Endoscopy (ASGE) complexity were associated with PEP. A higher proportion of patients who received rectal indomethacin (65% vs 47%, P = 0.002), or who had placement of a prophylactic (31% vs 20%, P = 0.01) or therapeutic PD stent (37% vs 27%, P = 0.04) developed PEP; however, in a subgroup analysis of high-risk patients, this association was not persistent. A smaller proportion of PEP patients had PRSS1 mutation compared to non-PEP patients (22% vs 40%, P = 0.04). CONCLUSIONS This study evaluates factors associated with developing PEP in a large pediatric cohort. A high rate of PEP was observed, likely secondary to higher rates of pancreatic indication and higher ASGE complexity scores compared to previously reported literature. Randomized prospective trials are needed to better define the utility of various interventions.
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Affiliation(s)
- Ahmad M Hassan
- From the Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Tom K Lin
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Milton T Smith
- From the Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Lindsey Hornung
- the Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maisam Abu-El-Haija
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jaimie D Nathan
- the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David S Vitale
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative. J Pediatr Gastroenterol Nutr 2022; 75:755-760. [PMID: 36122368 DOI: 10.1097/mpg.0000000000003612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs. METHODS In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events. RESULTS A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified. CONCLUSIONS This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.
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Interventional endoscopy for abdominal transplant patients. Semin Pediatr Surg 2022; 31:151190. [PMID: 35725058 DOI: 10.1016/j.sempedsurg.2022.151190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interventional endoscopy can play a significant role in the care and management of children pre-and post- abdominal solid organ transplantation. Such procedures primarily include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and balloon-assisted enteroscopy (BAE), though additional interventions are available using standard endoscopes (gastroscopes, colonoscopes) for therapeutics purposes such as endoscopic hemostasis. The availability of pediatric practitioners with the advanced training to effectively and safely perform these procedures are most often limited to large tertiary care pediatric centers. These centers possess the necessary resources and ancillary staff to provide the comprehensive multi-disciplinary care needed for these complex patients. In this review, we discuss the importance of interventional endoscopy in caring for transplant patients, during their clinical course preceding the potential need for solid organ transplantation and inclusion of a discussion related to endoscopic post-surgical complication management. Given the highly important role of interventional endoscopy in patients with recurrent and chronic pancreatitis, we also include a discussion related to this complex disease process leading up to those patients that may need pancreas surgery including total pancreatectomy with islet autotransplantation (TPIAT).
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