The utility of ERCP in pediatric pancreatic trauma

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.