Use of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Pediatric Pancreatic Injury

Abstract

Background

ERCP is the gold standard for evaluating the integrity of the main pancreatic duct (MPD); however, ERCP is underutilized in evaluating MPD integrity in pediatric blunt pediatric injury. The primary aim of this study was to evaluate the discordance of cross-sectional imaging (CSI) and ERCP in children with suspected MPD injury.

Methods

A retrospective review of all patients age ≤18 years with CSI or clinical findings suggestive of MPD injury (MPDI) and ERCP was conducted at a level I pediatric trauma center from January 2009 to May 2023. Demographic and clinical data were collected. Pancreatic injury findings were compared between cross-sectional imaging and ERCP.

Results

An ERCP was performed in 28 patients with suspected MPDI with a mean age of 7 ± 4.5 years and weight of 25.0 ± 13.6 kg. Based on initial CSI, 23 patients had a suspected MPDI, and 5 had concern for MPDI based on clinical findings. ERCP differed from CSI findings in 39% of patients: 7 with CSI evidence of MPDI without injury on ERCP and 4 patients without imaging concern of MPDI but demonstrated injury on ERCP. Findings on ERCP guided surgical management in 71% (20/28) of patients due to location and completeness of MPDI. All patients without MPDI were managed nonoperatively.

Conclusion

Approximately 40% of patients had discordant findings between ERCP and CSI. ERCP can aide in surgical management decision making. All patients with a partial MPDI were managed with endoscopic therapy alone. ERCP should be considered when assessing a child with a suspected MPDI.

Level of Evidence

Level III.

Type of Study

Diagnostic Study.