Endoscopy 2019; 51(04): S187
DOI: 10.1055/s-0039-1681723
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: Pediatric 1 ePoster Podium 6
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SPHINCTEROTOMY IN RECURRENT AND CHRONIC GENETIC PANCREATITIS IN CHILDREN

S Faraci
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
V Balassone
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
F Rea
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
F Torroni
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
EF Romeo
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
T Caldaro
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
AC Contini
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
R Tambucci
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
G Angelino
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
G Federici
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
P De Angelis
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
L Dall'Oglio
1   Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    Recurrent and chronic pancreatitis in children have a greater association with genetic mutations, such as mutations of the cationic trypsinogen protease serine 1 (PRSS1), serine protease inhibitor, Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator gene (CFTR), and chymotrypsin C (CTRC). Little literature to support endoscopic sphincterotomy, it usually is indicated in patients with higher burden of attacks.

    In our series we evaluate how ERCP with sphincterotomy and stent placement can improve symptoms and reduce episodes of pancreatitis in genetic pancreatitis in children.

    Methods:

    From 2012 to 2017, a total of 42 patients with recurrent and chronic pancreatitis with genetic mutations were identified and stratified in our centre. Sex, age, genetic mutation type, radiological investigations, endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, stent placement, clinical outcome post-endoscopic sphincterotomy (n°/pancreatitis with hospitalization) were evaluated.

    Results:

    We enrolled 42 patients (F/M 21/21; mean age 17 ys), 24 patients (57%; F/M 10/14 mean age 17 ys) underwent to endoscopic sphincterotomy; of these a stent was placed in 15 (63%) patients, instead 9 (37%) patients had only sphincterotomy. The remaining 18 patients (43%; F/M 11/7; mean age 13 ys) never had ERCP.

    All patients presented genetic mutations: 35 CFTR-related, 5 PRSS1, 2 SPINK1. All pazients had Ultrasound and Magnetic Resonance Cholangio-Pancreatography (MRCP) which documented Wirsung dilatation and dis-homogeneous pancreatic parenchyma.

    Comparing patients that had sfinterotomy and patients never had endoscopy with a good disease course, we observed a reduction in the number of attacks and hospitalization (19/24 – 79% vs. 14/18 – 77%; OR 1,09; BR 1,02); in particular patients who placed pancreatic stent improved their quality of life.

    Conclusions:

    Endoscopic sphincterotomy is a valid treatment strategy to improve clinical symptoms and reducing attacks and hospedalizations.


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