Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine.
J Pediatr Gastroenterol Nutr. 2021 Feb 1;72(2):300-305. doi: 10.1097/MPG.0000000000002996.
Pancreas divisum (PD) is a risk factor in children for the development of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (mPES) may be of clinical benefit, however, the clinical outcomes from endotherapy remain unclear. We sought to review the outcomes and safety of therapeutic ERCP in children with PD.
We performed a retrospective chart of children with PD who underwent an ERCP between February 2012 and December 2018. Pertinent patient, clinical and procedure information was collected including procedure-related adverse events. A follow-up questionnaire of the parent was conducted to determine the clinical impact from endotherapy.
Fifty-eight ERCPs were performed in 27 patients (14 boys; mean age: 9.7 years, range 2-19) with PD. All patients underwent a successful mPES. A genetic variant was identified in 19/26 (73%) tested patients. Post-ERCP pancreatitis (PEP) was the only observed adverse event; 21% (12/58). Median follow-up interval from first ERCP intervention to questionnaire completion was 31.5 months (range: 4--72 months). Of the 20 questionnaire responders, 13 reported clinical improvement from endotherapy.
The majority of children from our PD cohort possessed at least 1 genetic variant. Most questionnaire responders had a favorable response to endotherapy. PEP rate was comparable with that of prior reports in adult patients.
胰腺分裂症（PD）是儿童发生急性胰腺炎的危险因素。内镜下逆行胰胆管造影术（ERCP）联合小乳头内镜下括约肌切开术（mPES）可能具有临床获益，但内镜治疗的临床结局尚不清楚。我们旨在回顾 PD 儿童接受治疗性 ERCP 的结果和安全性。
我们对 2012 年 2 月至 2018 年 12 月期间接受 ERCP 的 PD 患儿进行了回顾性图表分析。收集了相关的患者、临床和程序信息，包括与程序相关的不良事件。对家长进行了随访问卷调查，以确定内镜治疗的临床影响。
27 例（14 名男孩；平均年龄：9.7 岁，范围 2-19 岁）PD 患儿共进行了 58 次 ERCP。所有患者均成功进行了 mPES。对 26 例（73%）接受检测的患者中的 19 例识别出了遗传变异。唯一观察到的不良事件是 ERCP 后胰腺炎（PEP）；占 21%（12/58）。首次 ERCP 干预到问卷调查完成的中位随访间隔为 31.5 个月（范围：4-72 个月）。在 20 名有应答的问卷回答者中，有 13 名报告内镜治疗有临床改善。
我们 PD 队列的大多数患儿至少有一种遗传变异。大多数问卷回答者对内镜治疗有良好的反应。PEP 发生率与先前成人患者的报告相似。
