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Hosseini A, Sohouli MH, Sharifi E, Sayyari A, Sridharan K, Tajalli S, Imanzadeh N, Fatahi S. Indications, success, and adverse event rates of pediatric endoscopic retrograde cholangiopancreatography (ERCP): a systematic review and meta-analysis. BMC Pediatr 2023; 23:596. [PMID: 37996785 PMCID: PMC10668434 DOI: 10.1186/s12887-023-04392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND To improve knowledge on endoscopic retrograde cholangiopancreatography (ERCP) in children, we aimed to study the proportion of indications, success rate and complication of ERCP. METHODS We performed a systematic search of all articles published up to December 2022 in the following databases: Cochrane Library, PubMed (MEDLINE) and Scopus. The meta-analysis was performed using a random-effects model. Heterogeneity was determined by the I2 statistics and the Cochrane Q test. The included data were analyzed to identify the proportion of indications, success rate and complications of ERCP in children. RESULTS Based on data from 52 studies with a total of 5624 participants, the most common indications for ERCP in children were biliary [48% (95% CI: 0.40 - 0.57; I2 = 98.17%, P < 0.001)] and both biliary and pancreatic [41% (95% CI: 0.33 - 0.49; I2 = 98.27%, P < 0.001)]. The success rate of ERCP was 95% (95% CI: 0.94 - 0.96; I2 = 82.53%, P < 0.001) with the overall complication rate of 7% (95% CI: 0.05 - 0.09; I2 = 82.06%, P < 0.001). The pooled estimate for the incidence of post ERCP pancreatitis was 4% (95% CI: 0.03 - 0.06; I2 = 85.46%, P < 0.001) and the bleeding was 0% (95% CI: 0.0 - 0.0; I2 = 28.21%, P = 0.03). CONCLUSIONS ERCP appears to be performed safely in children with a similar success rate as in the adult population.
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Affiliation(s)
- Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Sharifi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Sayyari
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Saleheh Tajalli
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Imanzadeh
- School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Shang ZY, Hong C, Liu CF. Case Report: Pancreaticopleural fistula with an atypical tract in a child with bulging chest. Front Pediatr 2023; 11:1278463. [PMID: 38027294 PMCID: PMC10643546 DOI: 10.3389/fped.2023.1278463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Pancreaticopleural fistula (PPF) is a rare but serious complication caused by pancreatic lesions that presents primarily with respiratory tract symptoms and pleural effusion. We report a paediatric case of PPF without any respiratory symptoms throughout the course of the disease, including cough or shortness of breath, with only a bulging chest as the first symptom. Imaging revealed a large left pleural effusion and Magnetic Resonance Cholangiopancreatography (MRCP) revealed a fistula formed between the pancreatic tail and the pleural cavity, which penetrated the diaphragm and opened in the central tendon of the diaphragm. The patient eventually underwent resection of the pancreatic tail lesion and repair of the diaphragmatic fistula and recovered soon thereafter.
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Affiliation(s)
- Zi Yin Shang
- Department of Pediatric Thoracic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
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Dimopoulou K, Dimopoulou A, Koliakos N, Tzortzis A, Dimopoulou D, Zavras N. Recognizing and Managing Pancreaticopleural Fistulas in Children. J INVEST SURG 2022; 35:1704-1710. [DOI: 10.1080/08941939.2022.2103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, “ATTIKON” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Koliakos
- Third Department of Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrianos Tzortzis
- Third Department of Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, “ATTIKON” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tri TT, Thach PN, Duy HP, Trung BH, Tuan HX, Duc NM. Pancreaticopleural fistula in children: Report of 2 cases. Radiol Case Rep 2022; 17:987-990. [PMID: 35106110 PMCID: PMC8784284 DOI: 10.1016/j.radcr.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Pancreaticopleural fistula is an extremely rare complication of pancreatic duct injury. The reported treatments include conservative approaches, such as pleural drainage, and interventional approaches, such as sphincter stenting via endoscopic retrograde cholangiopancreatography and surgery. However, no specific consensus treatment has been defined. We present 2 cases of pediatric patients with pancreaticopleural fistulas due to pancreatic trauma and pancreatitis that were successfully treated surgically. The most prominent symptom in both cases was dyspnea caused by pleural effusion. Thoracoabdominal computed tomography scans showed large pleural effusions and visible fistulas from the pancreatic duct to the thoracic cavity through the esophageal hiatus and aortic hiatus. Following unsuccessful conservative treatment using pleural drainage, the 2 patients underwent surgical fistulo-jejunostomy and cystojejunostomy. Both patients were stable and were discharged on postoperative days 10 and 12. Conservative treatment for pancreaticopleural fistula often fails, and a surgical approach, such as fistulo-jejunostomy and cystojejunostomy, can serve as an efficacious management strategy when conservative treatment fails.
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Affiliation(s)
- Tran Thanh Tri
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Pham Ngoc Thach
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Phi Duy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Bui Hai Trung
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Xuan Tuan
- Department of Radiology, School of Medicine and Pharmacy, University of Da Nang, Da Nang City, Vietnam
- Corresponding author. H.X. Tuan, 41 Le Duan, District Hai Chau, Da Nang City 500000, Vietnam.
| | - Nguyen Minh Duc
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Co-corresponding author. N.M. Duc, 2 Duong Quang Trung, District 10, Ho Chi Minh City 700000, Vietnam.
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Lim AYL, Gauld LM. Pleural effusion secondary to chronic pancreatitis in childhood. Respirol Case Rep 2021; 9:e00788. [PMID: 34094573 PMCID: PMC8150525 DOI: 10.1002/rcr2.788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/01/2023] Open
Abstract
Pleural effusion secondary to a pancreatico-pleural fistula is a very rare presentation in children, with limited reports in the literature. We describe two differing presentations of pleural effusions resulting from chronic pancreatitis (CP) with successful resolution of the pleural effusion. These cases highlight the need for consideration of this rare paediatric diagnosis, and the variety of investigations, management strategies, and complications that can occur in the setting of CP in children.
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Affiliation(s)
- Adeline Y. L. Lim
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
| | - Leanne M. Gauld
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandSt. LuciaQLDAustralia
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Khiatah B, Huynh T, Frugoli A, Lyche KD. Acute Pancreatitis with an Ongoing Pancreatic Duct Leak Complicated by Refractory Pleural Effusion: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931330. [PMID: 34112749 PMCID: PMC8207542 DOI: 10.12659/ajcr.931330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 52-year-old Final Diagnosis: Pancreatic duct leak Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Bashar Khiatah
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA
| | - Thatcher Huynh
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA
| | - Amanda Frugoli
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA.,Department of Graduate Medical Education, Community Memorial Hospital, Ventura, CA, USA
| | - Kip D Lyche
- Department of Gastroenterology, Community Memorial Health Systems, Ventura, CA, USA
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