Yield of Endoscopic Ultrasound in Children and Adolescent with Acute Recurrent Pancreatitis

ABSTRACT Objectives: Endoscopic ultrasound (EUS) is an established tool for evaluation of adults with acute recurrent pancreatitis (ARP) while data in pediatrics is limited. Our study assessed the role of EUS in identifying etiology including changes of chronic pancreatitis (CP) in children and adolescents with ARP. Methods: Children with ARP (≥2 episodes of acute pancreatitis) were prospectively evaluated with a detailed clinical proforma and EUS. Subjects with known etiology of ARP or CP on ultrasonography/computed tomography and magnetic resonance cholangio-pancreatography (MRCP, Cambridge grade ≥3) were excluded. Parenchymal and ductal changes on EUS as per minimal standards terminology features were noted. Results: 32 children (22 boys, age 14 [8–18] years) with ARP (median of 3[2–5] episodes of AP) were enrolled. EUS was safe and technically successful in all. GB sludge was found in 1 (3%) case and none had other pancreatobiliary structural abnormalities. EUS diagnosis of CP (≥4 features) was made in 10/32 (31%) cases. Subjects with CP on EUS had a longer disease duration than those without CP (45 [10–97] vs 22 [8–78] months; p = ns). MRCP was normal in 28 and showed pancreas divisum in 1 case. Three cases had equivocal (Cambridge II) changes at initial MRCP and 2 of them had repeat MRCP which showed definite (Cambridge IV) CP. All these 3 cases had CP on EUS. Conclusions: EUS diagnosed CP (≥4 features) in 31% and biliary abnormality in 3% children with ARP. EUS is safe, sensitive and useful for early diagnosis of CP in children with ARP. Address correspondence and reprint requests to Prof. Surender K. Yachha, MD, DM, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow- 226014, Uttar Pradesh, India (e-mail: skyachha@yahoo.co.in). Received 6 September, 2017 Accepted 16 November, 2017 Funding source: No funding was secured for this study. Conflict of interest: none of the authors have any conflict of interest Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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