Etiology of pancreatitis in pediatric patients and effect of endoscopic retrograde cholangiopancreatography_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Zhiqi ¹ , LI Yanni ¹ , XIE Xiaoxi ¹ , XIANG Bo ² ,  WANG Chunhui ^1,3

1. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Pediatric surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, , West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Chunhui, Email: wangch@scu.edu.cn

Keywords：

acute pancreatitis; chronic pancreatitis; pediatric; etiology; endoscopic retrograde cholangiopancreatography

DOI：

10.7507/1007-9424.202310038

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Objective To investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography (ERCP) in it. Methods Patients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan. 2008 to Jun. 2023 were included according to the inclusion and exclusion criteria. Totally, 241 cases (207 cases with acute pancreatitis and 34 with chronic pancreatitis) were included. Patients were divided into primary group (n=168) and recurrent group (n=73) according to their previous medical history. Results The duration of hospitalization in the primary group was longer than that in the recurrent group [10.0 (7.0, 16.0) d vs. 7.5 (6.0, 11.8) d, P=0.012]. The proportion of acute pancreatitis in primary group (163/168, 97.0%) was higher than that in the recurrent group (44/73, 60.3%), P<0.001. There was no significant difference in the etiological component ratio between the primary and recurrent groups (χ²=7.504, P=0.347). However, in the primary group, the first etiology was biliary factors (38/163, 23.3%), and the second was biliary pancreatic anatomic abnormality (22/163, 13.5%). In the recurrence group, biliary pancreatic anatomic abnormality (13/44, 29.5%) was the first cause, and biliary factor (7/44, 15.9%) was the second cause. Among 207 cases with acute pancreatitis, there were 114 cases (55.1%) with clear etiology, including 45 cases (21.7%) of biliary factors, 35 cases (16.9%) of abnormal biliary pancreatic structure, 12 cases (5.8%) of traumatic factors, and 10 cases (4.8%) of drug-induced factors. In this study, 66 cases were treated with ERCP for pancreatitis, and a total of 103 ERCP operations were performed with cannulation success rate of 100%. Twenty-three cases (23/37, 62.2%) of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP. In biliary acute pancreatitis, the removal rate of choledocholithiasis in single ERCP operation was 80.0% (8/10). The clinical symptoms (abdominal pain, jaundice, and fever) of all cases were significantly improved after surgery, and no complications such as cholangitis, bleeding and perforation occurred. Conclusions Biliary, congenital pancreatic anatomical abnormalities, drugs and trauma are the common causes of acute pancreatitis in children. ERCP is a safe and effective treatment for children with biliary pancreatitis, pancreatic anatomical abnormalities, and chronic pancreatitis.

Citation： CHEN Zhiqi, LI Yanni, XIE Xiaoxi, XIANG Bo, WANG Chunhui. Etiology of pancreatitis in pediatric patients and effect of endoscopic retrograde cholangiopancreatography. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 193-198. doi: 10.7507/1007-9424.202310038 Copy

1.	Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas, 2006, 33(4): 323-330.
2.	Frey CF, Zhou H, Harvey DJ, et al. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas, 2006, 33(4): 336-344.
3.	Yadav D, O'Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol, 2012, 107(7): 1096-1103.
4.	Sellers ZM, MacIsaac D, Yu H, et al. Nationwide trends in acute and chronic pancreatitis among privately insured children and non-elderly adults in the United States, 2007-2014. Gastroenterology, 2018, 155(2): 469-478. e1.
5.	Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas, 2010, 39(1): 5-8.
6.	Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr, 2011, 52(3): 262-270.
7.	Suzuki M, Minowa K, Isayama H, et al. Acute recurrent and chronic pancreatitis in children. Pediatr Int, 2021, 63(2): 137-149.
8.	Abu-El-Haija M, Kumar S, Quiros JA, et al. 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.
9.	中华医学会小儿外科学分会肝胆外科学组. 小儿慢性胰腺炎诊断与治疗专家共识 (2023). 中华小儿外科杂志, 2023, 44(7): 577-585.
10.	Afzal S, Kleinhenz J. Acute pancreatitis in children. Pediatr Ann, 2021, 50(8): e330-e335.
11.	Tagawa M, Morita A, Imagawa K, et al. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children. Dig Endosc, 2021, 33(7): 1045-1058.
12.	Greenfeld JI, Harmon CM. Acute pancreatitis. Curr Opin Pediatr, 1997, 9(3): 260-264.
13.	Park A, Latif SU, Shah AU, et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J Pediatr Gastroenterol Nutr, 2009, 49(3): 316-322.
14.	Perera KDR, Nawarathne NMM, Samarawickrama VT, et al. Endoscopic retrograde cholangiopancreatography in children: feasibility, success, and safety with standard adult endoscopes and accessories. Pediatr Gastroenterol Hepatol Nutr, 2022, 25(5): 406-412.
15.	Troendle DM, Barth BA. ERCP can be safely and effectively performed by a pediatric gastroenterologist for choledocholithiasis in a pediatric facility. J Pediatr Gastroenterol Nutr, 2013, 57(5): 655-658.
16.	Fishman DS, Chumpitazi BP, Raijman I, et al. Endoscopic retrograde cholangiography for pediatric choledocholithiasis: assessing the need for endoscopic intervention. World J Gastrointest Endosc, 2016, 8(11): 425-432.
17.	Morinville VD, Husain SZ, Bai H, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr, 2012, 55(3): 261-265.
18.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
19.	Davidson BR, Neoptolemos JP, Leese T, et al. Biochemical prediction of gallstones in acute pancreatitis: a prospective study of three systems. Br J Surg, 1988, 75(3): 213-215.
20.	van Geenen EJ, van der Peet DL, Bhagirath P, et al. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol, 2010, 7(9): 495-502.
21.	Meyer A, Coffey MJ, Oliver MR, et al. Contrasts and comparisons between childhood and adult onset acute pancreatitis. Pancreatology, 2013, 13(4): 429-435.
22.	DeBanto JR, Goday PS, Pedroso MR, et al. Acute pancreatitis in children. Am J Gastroenterol, 2002, 97(7): 1726-1731.
23.	Soares KC, Goldstein SD, Ghaseb MA, et al. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int, 2017, 33(6): 637-650.
24.	Meczker Á, Hanák L, Párniczky A, et al. Analysis of 1 060 cases of drug-induced acute pancreatitis. Gastroenterology, 2020, 159(5): 1958-1961.e8.
25.	Wolfe D, Kanji S, Yazdi F, et al. Drug induced pancreatitis: a systematic review of case reports to determine potential drug associations. PLoS One, 2020, 15(4): e0231883. doi: 10.1371/journal.pone.0231883.
26.	Ooi CY, Gonska T, Durie PR, et al. Genetic testing in pancreatitis. Gastroenterology, 2010, 138(7): 2202-2206.e1.
27.	Uc A, Husain SZ. Pancreatitis in children. Gastroenterology, 2019, 156(7): 1969-1978.
28.	Grover AS, Gugig R, Barakat MT. Endoscopy and pediatric pancreatitis. Gastrointest Endosc Clin N Am, 2023, 33(2): 363-378.
29.	Makita S, Amano H, Kawashima H, et al. Utility of endoscopic retrograde cholangiopancreatography in management of pediatric pancreaticobiliary disease. BMC Pediatr, 2022, 22(1): 134. doi: 10.1186/s12887-022-03207-3.
30.	Kohut M, Nowak A, Nowakowska-Duława E, et al. The frequency of bile duct crystals in patients with presumed biliary pancreatitis. Gastrointest Endosc, 2001, 54(1): 37-41.
31.	Pérez-Martín G, Gómez-Cerezo J, Codoceo R, et al. Bilirubinate granules: main pathologic bile component in patients with idiopathic acute pancreatitis. Am J Gastroenterol, 1998, 93(3): 360-362.
32.	Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med, 1992, 326(9): 589-593.
33.	Lehman GA. Role of ERCP and other endoscopic modalities in chronic pancreatitis. Gastrointest Endosc, 2002, 56(6 Suppl): 237-240.
34.	Trocchia C, Khalaf R, Amankwah E, et al. Pediatric ERCP in the setting of acute pancreatitis: a secondary analysis of an international multicenter cohort study. J Pediatr Gastroenterol Nutr, 2023, 76(6): 817-821.
35.	Troendle DM, Ruan W, Fishman DS, et al. Technical outcomes in pediatric endoscopic retrograde cholangiopancreatography: data from an international collaborative. J Pediatr Gastroenterol Nutr, 2022, 75(6): 755-760.
36.	Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA, 2019, 322(24): 2422-2434.
37.	Testoni PA, Caporuscio S, Bagnolo F, et al. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol, 2000, 95(7): 1702-1707.
38.	Tarnasky PR, Hawes RH. Endoscopic diagnosis and therapy of unexplained (idiopathic) acute pancreatitis. Gastrointest Endosc Clin N Am, 1998, 8(1): 13-37.
39.	Majbar AA, Cusick E, Johnson P, et al. Incidence and clinical associations of childhood acute pancreatitis. Pediatrics, 2016, 138(3): e20161198. doi: 10.1542/peds.2016-1198.
40.	Restrepo R, Hagerott HE, Kulkarni S, et al. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol, 2016, 206(3): 632-644.

1. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas, 2006, 33(4): 323-330.
2. Frey CF, Zhou H, Harvey DJ, et al. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas, 2006, 33(4): 336-344.
3. Yadav D, O'Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol, 2012, 107(7): 1096-1103.
4. Sellers ZM, MacIsaac D, Yu H, et al. Nationwide trends in acute and chronic pancreatitis among privately insured children and non-elderly adults in the United States, 2007-2014. Gastroenterology, 2018, 155(2): 469-478. e1.
5. Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas, 2010, 39(1): 5-8.
6. Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr, 2011, 52(3): 262-270.
7. Suzuki M, Minowa K, Isayama H, et al. Acute recurrent and chronic pancreatitis in children. Pediatr Int, 2021, 63(2): 137-149.
8. Abu-El-Haija M, Kumar S, Quiros JA, et al. 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.
9. 中华医学会小儿外科学分会肝胆外科学组. 小儿慢性胰腺炎诊断与治疗专家共识 (2023). 中华小儿外科杂志, 2023, 44(7): 577-585.
10. Afzal S, Kleinhenz J. Acute pancreatitis in children. Pediatr Ann, 2021, 50(8): e330-e335.
11. Tagawa M, Morita A, Imagawa K, et al. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children. Dig Endosc, 2021, 33(7): 1045-1058.
12. Greenfeld JI, Harmon CM. Acute pancreatitis. Curr Opin Pediatr, 1997, 9(3): 260-264.
13. Park A, Latif SU, Shah AU, et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J Pediatr Gastroenterol Nutr, 2009, 49(3): 316-322.
14. Perera KDR, Nawarathne NMM, Samarawickrama VT, et al. Endoscopic retrograde cholangiopancreatography in children: feasibility, success, and safety with standard adult endoscopes and accessories. Pediatr Gastroenterol Hepatol Nutr, 2022, 25(5): 406-412.
15. Troendle DM, Barth BA. ERCP can be safely and effectively performed by a pediatric gastroenterologist for choledocholithiasis in a pediatric facility. J Pediatr Gastroenterol Nutr, 2013, 57(5): 655-658.
16. Fishman DS, Chumpitazi BP, Raijman I, et al. Endoscopic retrograde cholangiography for pediatric choledocholithiasis: assessing the need for endoscopic intervention. World J Gastrointest Endosc, 2016, 8(11): 425-432.
17. Morinville VD, Husain SZ, Bai H, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr, 2012, 55(3): 261-265.
18. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
19. Davidson BR, Neoptolemos JP, Leese T, et al. Biochemical prediction of gallstones in acute pancreatitis: a prospective study of three systems. Br J Surg, 1988, 75(3): 213-215.
20. van Geenen EJ, van der Peet DL, Bhagirath P, et al. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol, 2010, 7(9): 495-502.
21. Meyer A, Coffey MJ, Oliver MR, et al. Contrasts and comparisons between childhood and adult onset acute pancreatitis. Pancreatology, 2013, 13(4): 429-435.
22. DeBanto JR, Goday PS, Pedroso MR, et al. Acute pancreatitis in children. Am J Gastroenterol, 2002, 97(7): 1726-1731.
23. Soares KC, Goldstein SD, Ghaseb MA, et al. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int, 2017, 33(6): 637-650.
24. Meczker Á, Hanák L, Párniczky A, et al. Analysis of 1 060 cases of drug-induced acute pancreatitis. Gastroenterology, 2020, 159(5): 1958-1961.e8.
25. Wolfe D, Kanji S, Yazdi F, et al. Drug induced pancreatitis: a systematic review of case reports to determine potential drug associations. PLoS One, 2020, 15(4): e0231883. doi: 10.1371/journal.pone.0231883.
26. Ooi CY, Gonska T, Durie PR, et al. Genetic testing in pancreatitis. Gastroenterology, 2010, 138(7): 2202-2206.e1.
27. Uc A, Husain SZ. Pancreatitis in children. Gastroenterology, 2019, 156(7): 1969-1978.
28. Grover AS, Gugig R, Barakat MT. Endoscopy and pediatric pancreatitis. Gastrointest Endosc Clin N Am, 2023, 33(2): 363-378.
29. Makita S, Amano H, Kawashima H, et al. Utility of endoscopic retrograde cholangiopancreatography in management of pediatric pancreaticobiliary disease. BMC Pediatr, 2022, 22(1): 134. doi: 10.1186/s12887-022-03207-3.
30. Kohut M, Nowak A, Nowakowska-Duława E, et al. The frequency of bile duct crystals in patients with presumed biliary pancreatitis. Gastrointest Endosc, 2001, 54(1): 37-41.
31. Pérez-Martín G, Gómez-Cerezo J, Codoceo R, et al. Bilirubinate granules: main pathologic bile component in patients with idiopathic acute pancreatitis. Am J Gastroenterol, 1998, 93(3): 360-362.
32. Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med, 1992, 326(9): 589-593.
33. Lehman GA. Role of ERCP and other endoscopic modalities in chronic pancreatitis. Gastrointest Endosc, 2002, 56(6 Suppl): 237-240.
34. Trocchia C, Khalaf R, Amankwah E, et al. Pediatric ERCP in the setting of acute pancreatitis: a secondary analysis of an international multicenter cohort study. J Pediatr Gastroenterol Nutr, 2023, 76(6): 817-821.
35. Troendle DM, Ruan W, Fishman DS, et al. Technical outcomes in pediatric endoscopic retrograde cholangiopancreatography: data from an international collaborative. J Pediatr Gastroenterol Nutr, 2022, 75(6): 755-760.
36. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA, 2019, 322(24): 2422-2434.
37. Testoni PA, Caporuscio S, Bagnolo F, et al. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol, 2000, 95(7): 1702-1707.
38. Tarnasky PR, Hawes RH. Endoscopic diagnosis and therapy of unexplained (idiopathic) acute pancreatitis. Gastrointest Endosc Clin N Am, 1998, 8(1): 13-37.
39. Majbar AA, Cusick E, Johnson P, et al. Incidence and clinical associations of childhood acute pancreatitis. Pediatrics, 2016, 138(3): e20161198. doi: 10.1542/peds.2016-1198.
40. Restrepo R, Hagerott HE, Kulkarni S, et al. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol, 2016, 206(3): 632-644.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Etiology of pancreatitis in pediatric patients and effect of endoscopic retrograde cholangiopancreatography

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