Influence of ERCP on the diagnosis and treatment of pediatric patients with symptomatic pancreatitis (SP) and cystic fibrosis (CF)

Introduction: Patients with cystic fibrosis, and symptomatic pancreatitis, frequently have severe symptoms of abdominal pain which is difficult to manage. This study was done to evaluate whether ERCP could diagnose treatable lesions, and direct subsequent treatment in such patients to reduce clinical pancreatitis pain. Methods: Retrospective study. Between 9-91 and 12-95, 64 ERCPs were done on 50 pediatric patients; 9 of these were done on 4 patients with CF and SP: [4 ERCP; 5 dorsal ERP+ 2 sphincterotomies & 3 dorsal stone extractions; 2 pancreatic S.O. manometries; 1 biliary spincterotomy (ES)]. All patients had preERCP US or CT scans of the pancreas. General anesthesia was used in all patients. Ages were 4 years to 16 years. All had ≥3 episodes of SP. All failed conservative therapy. Results: CT showed pancreas duct dilation in 1 patient; otherwise normal. There was 1 case of mild pancreatitis (3 day hospitalization). PATIENT # (& Findings) TREATMENT OUTCOME 1/ Elevated ventral panc basal pressure Biliary ES No further pancreatitis >6 month 2/ P. Divisum w/ panc stones + duct dilation Dorsal ES + stone extraction; later Puestow SP < twice/yr over 3 year F/U 3/ Chronic changes in panc duct tail Distal pancreatic resection No further pancreatitis >3 month 4/ Normal ERCP None no further pancreatits >2 years Summary/Conclusion: ERCP was helpful in diagnosing and in directing therapy in 3 of 4 CF patients with SP. Procedure morbidity was low. ERCP and related therapeutics should be considered in CF patients with SP who fail conservative treatment.