Pancreatitis

A number of reports have recently emerged on the utility of endoscopic ultrasosund (EUS) in chronic pancreatitis in childhood. However, the concept in children was utilized as early as 1998, and then later reported specifically for pancreaticobiliary disorders in 2005. This indication is more for diagnostic utility than therapeutic input. EUS‐guided fine needle aspiration (EUS‐FNA) has been found useful for the diagnosis of idiopathic fibrosing pancreatitis and EUS‐guided Trucut needle biopsy may facilitate diagnosis of pathologies such as autoimmune pancreatitis in a relatively minimally invasive fashion. Microlithiasis may be identified as a putative contributor in chronic intermittent pancreatitis in children by EUS (see Chapter 16).

Pancreatic pseudocysts

Pancreatic pseudocysts are secondary to pancreatic damage and may be multietiological: traumatic; post pancreatitis of idiopathic origin; following chemotherapy; or any other cause of acute pancreatitis. They should be differentiated from malignant cysts but this is unusual in childhood and is a distinction necessary predominantly only in adult practice.

Presentation may be with a persistently raised amylase/lipase, with chronic pain, as an abdominal mass, or with consistent nausea/vomiting. Treatment to date has been either conservative, surgical, with the use of (as yet unproven) antisecretory agents such as octreotide or its longer‐acting analogues (e.g., lanreotide), or via ERCP. More recently, transgastric cystostomies have been formed by endoscopy [1]. These are either guided by endo‐ultrasound, which is a safer option avoiding gastric vessels (Figure 38.1), or blind with prior epinephrine injection into the bulge in the gastric wall from the luminal surface and then incision into the injected area. The former is preferable using linear endo‐ultrasound ideally but radial endo‐ultrasound may at times be sufficient and has been described in children [2–5]. Indeed, EUS has become the accepted imaging and guiding procedure for drainage of pancreatic fluid collections in the past decade. EUS has been shown to be safe and effective and it has been the first‐line therapy for uncomplicated pseudocysts.

Where walled‐off pancreatic necrosis was originally thought to be a contraindication for endoscopic treatment, multiple case series have now shown that these fluid collections also can be treated endoscopically with low morbidity and mortality [6]. Usually, the cyst can be indirectly identified abutting the lesser or greater curvature and is quite obvious as a mass effect into the gastric lumen hence it is not mandatory to use EUS in obvious cases (Figure 38.2).

Related posts:

Pediatric endoscopy training and ongoing assessment Pediatric procedural sedation and general anesthesia for gastrointestinal endoscopy Celiac disease Transnasal gastrointestinal endoscopy Endoscopic management of esophageal strictures Endoscopic approaches to the treatment of gastroesophageal reflux disease

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