The utility of ERCP in pediatric pancreatic trauma

Eric H. Rosenfeld, Adam M. Vogel, Denise B. Klinkner, Mauricio Escobar, Barbara Gaines, Robert Russell, Brendan Campbell, Hale Wills, Anthony Stallion, David Juang, Rajan K. Thakkar, Jeffrey Upperman, Mubeen Jafri, Randall Burd, Bindi J. Naik-Mathuria

Research output: Contribution to journalArticle

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Abstract

Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7-211) vs 7 (4-12) days; p = 0.55], similar hospital days: [12 (8-20) vs 11 (6-19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10-40) vs 10 (6-18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Pediatrics
Wounds and Injuries
Fistula
Pathologic Constriction
Nonparametric Statistics
Nonpenetrating Wounds
Trauma Centers
Pancreatic Ducts
Parenteral Nutrition
Stents
Retrospective Studies
Diet

Keywords

  • Blunt abdominal trauma
  • ERCP
  • Pancreatic stent
  • Pediatric pancreatic trauma
  • Pediatric trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Rosenfeld, E. H., Vogel, A. M., Klinkner, D. B., Escobar, M., Gaines, B., Russell, R., ... Naik-Mathuria, B. J. (Accepted/In press). The utility of ERCP in pediatric pancreatic trauma. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.10.038

The utility of ERCP in pediatric pancreatic trauma. / Rosenfeld, Eric H.; Vogel, Adam M.; Klinkner, Denise B.; Escobar, Mauricio; Gaines, Barbara; Russell, Robert; Campbell, Brendan; Wills, Hale; Stallion, Anthony; Juang, David; Thakkar, Rajan K.; Upperman, Jeffrey; Jafri, Mubeen; Burd, Randall; Naik-Mathuria, Bindi J.

In: Journal of Pediatric Surgery, 01.01.2017.

Research output: Contribution to journalArticle

Rosenfeld, EH, Vogel, AM, Klinkner, DB, Escobar, M, Gaines, B, Russell, R, Campbell, B, Wills, H, Stallion, A, Juang, D, Thakkar, RK, Upperman, J, Jafri, M, Burd, R & Naik-Mathuria, BJ 2017, 'The utility of ERCP in pediatric pancreatic trauma', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.10.038
Rosenfeld EH, Vogel AM, Klinkner DB, Escobar M, Gaines B, Russell R et al. The utility of ERCP in pediatric pancreatic trauma. Journal of Pediatric Surgery. 2017 Jan 1. https://doi.org/10.1016/j.jpedsurg.2017.10.038
Rosenfeld, Eric H. ; Vogel, Adam M. ; Klinkner, Denise B. ; Escobar, Mauricio ; Gaines, Barbara ; Russell, Robert ; Campbell, Brendan ; Wills, Hale ; Stallion, Anthony ; Juang, David ; Thakkar, Rajan K. ; Upperman, Jeffrey ; Jafri, Mubeen ; Burd, Randall ; Naik-Mathuria, Bindi J. / The utility of ERCP in pediatric pancreatic trauma. In: Journal of Pediatric Surgery. 2017.
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abstract = "Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50{\%}), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7-211) vs 7 (4-12) days; p = 0.55], similar hospital days: [12 (8-20) vs 11 (6-19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10-40) vs 10 (6-18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III.",
keywords = "Blunt abdominal trauma, ERCP, Pancreatic stent, Pediatric pancreatic trauma, Pediatric trauma",
author = "Rosenfeld, {Eric H.} and Vogel, {Adam M.} and Klinkner, {Denise B.} and Mauricio Escobar and Barbara Gaines and Robert Russell and Brendan Campbell and Hale Wills and Anthony Stallion and David Juang and Thakkar, {Rajan K.} and Jeffrey Upperman and Mubeen Jafri and Randall Burd and Naik-Mathuria, {Bindi J.}",
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AU - Russell, Robert

AU - Campbell, Brendan

AU - Wills, Hale

AU - Stallion, Anthony

AU - Juang, David

AU - Thakkar, Rajan K.

AU - Upperman, Jeffrey

AU - Jafri, Mubeen

AU - Burd, Randall

AU - Naik-Mathuria, Bindi J.

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N2 - Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7-211) vs 7 (4-12) days; p = 0.55], similar hospital days: [12 (8-20) vs 11 (6-19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10-40) vs 10 (6-18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III.

AB - Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7-211) vs 7 (4-12) days; p = 0.55], similar hospital days: [12 (8-20) vs 11 (6-19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10-40) vs 10 (6-18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III.

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KW - Pancreatic stent

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