Endoscopic intervention improves symptoms in pediatric pancreas divisum

CHICAGO — Therapeutic intervention with endoscopic retrograde cholangiopancreatography in children with pancreas divisum demonstrated a high technical success rate, according to a presentation at NASPGHAN 2019.

“In either complete or incomplete pancreas divisum, the pathogenicity is the same: a small minor papillary orifice results in increased intraductal pressure within the dorsal pancreatic duct causing inadequate drainage, pain or pancreatitis,” Tom Lin, MD, from the Cincinnati Children’s Hospital Medical Center in Ohio, said during his presentation.

Lin explained that pancreas divisum has been found in up to 15% of children as a risk factor for those with established acute recurrent pancreatitis and chronic pancreatitis compared with 7% of the general population.

To better understand the clinical outcomes of pancreas divisum in children and identify the technical success and safety of endoscopic retrograde cholangiopancreatography (ERCP), Lin and colleagues retrospectively reviewed pediatric data from his center.

Between February 2012 and December 2018, they found 58 ERCP reports performed in 28 patients. Patient age ranged from 2 years to 19 years. Nineteen patients had a genetic mutation in one of the pancreatitis genes.

Among the 20 families available for a follow-up phone survey, 13 reported clinical improvement from ERCP including four patients with resolved pancreas symptoms and nine with improve symptoms. Of those 13, only one patient went on to total pancreatectomy with islet autotransplantation (TPIAT) due to ongoing significant symptoms despite initial improvement.

Five patients who did not respond to ERCP underwent TPIAT due to persistent debilitating symptoms or pancreatitis episodes.

Procedure-related adverse events were limited to post-ERCP pancreatitis and occurred in 12 patients.

“Genetic mutations were found to be a common cofactor in approximately 70% of children with pancreas divisum,” Lin pointed out. “A subset of children with pancreas divisum may fail to adequately improve following ERCP and may need surgical intervention with TPIAT; however, we found that therapeutic ERCP had a high technical success rate with low rates of adverse events.” – by Talitha Bennett

Reference:

Lin T, et al. Abstract 664. Presented at: NASPGHAN; October 17-19, 2019; Chicago.

Disclosures: Lin reports no relevant financial disclosures.