Pancreatobiliary Endoscopic Interventions for Pediatric Pancreatic Pathology
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INVITED REVIEW
Pancreatobiliary Endoscopic Interventions for Pediatric Pancreatic Pathology Jaya Agarwal1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology. Keywords Pediatric · Pancreatitis · EUS · ERCP · Endoscopy · Pancreatic fluid collection Abbreviations ERCP Endoscopic retrograde cholangiopancreatography EUS Endoscopic ultrasound FNA Fine-needle aspiration AP Acute pancreatitis AIP Autoimmune pancreatitis CP Chronic pancreatitis ARP Acute recurrent pancreatitis PFC Pancreatic fluid collections WOPN Walled-off pancreatic necrosis PBM Pancreaticobiliary maljunction CPN Celiac axis neurolysis
Introduction Owing to the growing incidence of pediatric pancreatic diseases globally over the past few decades, there is an increasing need for their advanced endoscopic management [1, 2]. Even though the etiology, clinical presentation, severity, and outcome in children vary from the adult, the current understanding and approach to the management of pediatric pancreatic diseases is mostly based on studies in adults owing to the sparse literature available in children [3, 4].
Advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) have become the cornerstone in the management of pancreatic diseases in adults. EUS and ERCP are being used increasingly in children, but there remains a huge knowledge gap, contributed by constraining factors such as the fewer cases in pediatric age group, the absence of availability of appropriate-sized endoscopic equipments, lesser number of pediatric advanced endoscopists, and limited awareness among pediatricians about their diagnostic and therapeutic capabilities. In this review, we aim to describe various pediatric pancreatic conditions in which ERCP and EUS substantially contribute to their optimum management. We also review the outcomes, efficacy, and adverse events related to these advanced modalities on the basis of the published pediatric literature.
Pre‑procedural Technical Considerations in Children Advanced endoscopic procedures in children are challenging in terms of the availability of the correct size of endoscopes and also with issues related to sedation.
* Jaya Agarwal [email protected] 1
Regency Health, Kanpur, India
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Endoscopes Endoscopic Retrograde Cholangiopancreatography (ERCP) Pediatric ERCP is primarily limited by the lack o
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