In pediatric patients with chronic pancreatitis, the vast majority of pancreatic duct stones are soft and non-calcified, making them readily and easily removed with standard endoscopic therapies using baskets or retrieval balloons.
Lithotripsy options for calcified pancreatic duct stones include mechanical lithotripsy using a basket, electrohydraulic lithotripsy, laser therapy under direct visualization, and extracorporeal shock wave lithotripsy (ESWL).
Serial stenting for pancreatic duct strictures should be performed for a maximum of one year; if strictures remain recalcitrant beyond one year, other interventions including surgical options should be considered.
For pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing.
ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes.
In adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited.
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 43:34
clinicalIn adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited.↗
▶Ep 5 · 53:05
clinicalFor pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing.↗
Pancreas Care Updates 2020 - FULL SHOW
▶Ep 7 · 41:40
clinicalERCP continues to be the gold standard for pancreatic duct imaging in children and is reserved for therapeutic interventions, with some exceptions for diagnostic purposes such as pancreatic trauma.↗
▶Ep 7 · 42:20
clinicalThere is no age limitation for performing ERCP at Cincinnati Children's; even neonates can undergo successful and safe ERCP with appropriate equipment and accessories.↗
▶Ep 7 · 42:40
clinicalAltered surgical anatomy including Roux-en-Y is no longer a significant limitation for ERCP due to balloon enteroscopy techniques.↗
▶Ep 7 · 43:10
clinicalMRCP has false negative rates for pancreatic duct stones, chronic pancreatitis findings, and anomalous pancreaticobiliary junction (APBJ), which may be overlooked depending on stone size or patient size.↗
▶Ep 7 · 44:00
quoteERCP in children for chronic pancreatitis and pancreatic indications is more technically difficult and complex in kids compared to performing similar procedures on adults and they go, again that goes back to our personal experience at our center which um we do get um many referrals from across the country.↗
▶Ep 7 · 44:00
opinionERCP in children for chronic pancreatitis and pancreatic indications is more technically difficult and complex compared to performing similar procedures on adults, based on Cincinnati Children's experience with referrals from across the country.↗
▶Ep 7 · 45:00
epidemiologicalPost-ERCP pancreatitis is the greatest risk factor from ERCP, with rates of 3 to 11% in larger pediatric cohort studies, equivalent to adult rates.↗
▶Ep 7 · 45:20
epidemiologicalOther ERCP complications including perforation, bleeding, and infection occur at 1% or less in pediatric studies.↗
▶Ep 7 · 46:20
clinicalPancreatic duct stents are temporary; there is no consideration for permanent stents in the pancreatic duct at the current time.↗
▶Ep 7 · 47:30
clinicalSerial stenting for pancreatic duct strictures should be performed for a maximum of one year; if strictures remain recalcitrant beyond one year, other interventions including surgical options should be considered.↗
▶Ep 7 · 49:40
clinicalIn pediatric patients with chronic pancreatitis, the vast majority of pancreatic duct stones are soft and non-calcified, making them readily and easily removed with standard endoscopic therapies using baskets or retrieval balloons.↗
▶Ep 7 · 50:20
clinicalLithotripsy options for calcified pancreatic duct stones include mechanical lithotripsy using a basket, electrohydraulic lithotripsy, laser therapy under direct visualization, and extracorporeal shock wave lithotripsy (ESWL).↗
▶Ep 7 · 57:30
clinicalPancreas divisum is the most common congenital anomaly of the pancreas and is a known risk factor for acute recurrent pancreatitis and chronic pancreatitis.↗
▶Ep 7 · 57:50
epidemiologicalPancreas divisum has a prevalence of 7% in the general healthy population and 15% in the International Study Group cohort of children with acute recurrent and chronic pancreatitis.↗
▶Ep 7 · 58:50
clinicalAt Cincinnati Children's, nearly two-thirds of pancreas divisum patients who underwent therapeutic ERCP with minor papilla sphincterotomy had either symptom improvement or complete symptom resolution.↗
Tom's statements about Acute Recurrent Pancreatitis17 statements
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 43:34
clinicalIn adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited.↗
▶Ep 5 · 53:05
clinicalFor pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing.↗
Pancreas Care Updates 2020 - FULL SHOW
▶Ep 7 · 41:40
clinicalERCP continues to be the gold standard for pancreatic duct imaging in children and is reserved for therapeutic interventions, with some exceptions for diagnostic purposes such as pancreatic trauma.↗
▶Ep 7 · 42:20
clinicalThere is no age limitation for performing ERCP at Cincinnati Children's; even neonates can undergo successful and safe ERCP with appropriate equipment and accessories.↗
▶Ep 7 · 42:40
clinicalAltered surgical anatomy including Roux-en-Y is no longer a significant limitation for ERCP due to balloon enteroscopy techniques.↗
▶Ep 7 · 43:10
clinicalMRCP has false negative rates for pancreatic duct stones, chronic pancreatitis findings, and anomalous pancreaticobiliary junction (APBJ), which may be overlooked depending on stone size or patient size.↗
▶Ep 7 · 44:00
quoteERCP in children for chronic pancreatitis and pancreatic indications is more technically difficult and complex in kids compared to performing similar procedures on adults and they go, again that goes back to our personal experience at our center which um we do get um many referrals from across the country.↗
▶Ep 7 · 44:00
opinionERCP in children for chronic pancreatitis and pancreatic indications is more technically difficult and complex compared to performing similar procedures on adults, based on Cincinnati Children's experience with referrals from across the country.↗
▶Ep 7 · 45:00
epidemiologicalPost-ERCP pancreatitis is the greatest risk factor from ERCP, with rates of 3 to 11% in larger pediatric cohort studies, equivalent to adult rates.↗
▶Ep 7 · 45:20
epidemiologicalOther ERCP complications including perforation, bleeding, and infection occur at 1% or less in pediatric studies.↗
▶Ep 7 · 46:20
clinicalPancreatic duct stents are temporary; there is no consideration for permanent stents in the pancreatic duct at the current time.↗
▶Ep 7 · 47:30
clinicalSerial stenting for pancreatic duct strictures should be performed for a maximum of one year; if strictures remain recalcitrant beyond one year, other interventions including surgical options should be considered.↗
▶Ep 7 · 49:40
clinicalIn pediatric patients with chronic pancreatitis, the vast majority of pancreatic duct stones are soft and non-calcified, making them readily and easily removed with standard endoscopic therapies using baskets or retrieval balloons.↗
▶Ep 7 · 50:20
clinicalLithotripsy options for calcified pancreatic duct stones include mechanical lithotripsy using a basket, electrohydraulic lithotripsy, laser therapy under direct visualization, and extracorporeal shock wave lithotripsy (ESWL).↗
▶Ep 7 · 57:30
clinicalPancreas divisum is the most common congenital anomaly of the pancreas and is a known risk factor for acute recurrent pancreatitis and chronic pancreatitis.↗
▶Ep 7 · 57:50
epidemiologicalPancreas divisum has a prevalence of 7% in the general healthy population and 15% in the International Study Group cohort of children with acute recurrent and chronic pancreatitis.↗
▶Ep 7 · 58:50
clinicalAt Cincinnati Children's, nearly two-thirds of pancreas divisum patients who underwent therapeutic ERCP with minor papilla sphincterotomy had either symptom improvement or complete symptom resolution.↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 6 · 43:34
clinicalIn adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited.↗
▶Ep 6 · 43:34
clinicalIn adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited.↗
▶Ep 6 · 47:34
clinicalERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes.↗
▶Ep 6 · 53:05
clinicalFor pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing.↗
▶Ep 6 · 53:05
clinicalFor pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing.↗
Summaries Tom gave as host
· 3 summaries
Recaps of other experts' statements, not Tom's own clinical position.
Summaries Tom gave as host · Acute Pancreatitis1 summary
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 47:34
host summaryTom Lin summarizing the discussion: ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes.↗
Summaries Tom gave as host · Acute Recurrent Pancreatitis1 summary
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 47:34
host summaryTom Lin summarizing the discussion: ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes.↗
Summaries Tom gave as host · Pancreatitis1 summary
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 6 · 47:34
host summaryTom Lin summarizing the discussion: ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes.↗
