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Update Course Rewind: Management of Recurrent Pancreatitis

Video Published 2024-05-28 Updated 2026-08-01

Timestops (4)

Recurrent Pancreatitis Case Presentation

Genetic Testing and Mutation Analysis

Imaging and Diagnostic Workup

Treatment Strategy and Endoscopic Management

Topic Overview

A pediatric surgery educational discussion on managing recurrent pancreatitis in children, centered on a case of a 7-year-old with acute recurrent pancreatitis who has undergone 7 ERCPs. The discussion emphasizes the critical role of genetic testing before surgical intervention, as genetic mutations (particularly PRSS1) alter treatment strategy away from drainage procedures toward total pancreatectomy with islet autotransplantation (TPIAT). Key clinical points include the risk of islet cell loss with repeated pancreatitis attacks, the limitations of endoscopic therapy in genetically-driven disease, and conservative management of asymptomatic fluid collections.

Key Takeaways

Obtain genetic panel (PRSS1, CTRC, CFTR) after first severe or second episode of acute pancreatitis to guide treatment decisions.
Avoid Frey procedure in genetic mutations—resection loses islet cells without preventing ongoing parenchymal attacks from mutation.
Refer for TPIAT evaluation when endoscopic management fails rather than continuing multiple ERCPs that risk further islet cell loss.
Drain pancreatic fluid collections only if symptomatic (pain, gastric outlet obstruction); asymptomatic collections self-resolve.
MRCP with T2 sequences is best non-invasive imaging; ERCP is therapeutic not diagnostic after initial workup.

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Speaker 1 — host
Cecilia Gena — host
Juan Gurria — guest
Speaker 4
Speaker 5
Speaker 6

Chapters

0:01Case Presentation and Initial Management Options — Introduction of a 7-year-old with acute recurrent pancreatitis, 7 prior ERCPs, and pancreatic duct stricture. Audience polled on management approach including repeat ERCP, genetic testing, or Frey procedure.
1:28Role of Genetics in Treatment Planning — Discussion of genetic mutations in pancreatitis (PRSS1, CTRC, CFTR, CPA1) and how genetic findings alter surgical approach. Explanation of why Frey procedure may be inappropriate in genetic pancreatitis due to ongoing parenchymal attacks and islet cell loss.
3:37Timing of Referral and Imaging Strategies — Guidance on when to refer for specialized care, role of endoscopic management, and imaging modalities including ultrasound, CT, MRCP with T2 sequences, and endoscopic ultrasound.
5:11Fluid Collections and Summary — Management of pancreatic fluid collections (drain only if symptomatic after 4-6 weeks of wall maturation) and summary of key principles for recurrent pancreatitis management.

Key claims

1:40Every ERCP carries a risk of post-ERCP pancreatitis, and islet cells are lost with every pancreatitis attack — Juan Gurria
1:57PRSS1 is the most common genetic mutation in pediatric pancreatitis and is a trypsinogen activator that activates trypsin inside the pancreas — Juan Gurria
2:12Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis — Juan Gurria
2:17Genetic factors are changing the approach to pediatric chronic pancreatitis treatment — Juan Gurria
2:26Patients with more than 1 episode of acute pancreatitis or a first severe episode should undergo MRCP and genetic panel testing — Cecilia Gena
2:48There is currently no medication to mediate trypsin activation in genetic pancreatitis — Juan Gurria
3:09Frey procedure requires removing the top half of the pancreas to open the duct, resulting in loss of islet cells — Juan Gurria
3:19In patients with PRSS1 mutation, drainage procedures only temporize attacks by draining the duct but do not fix the underlying problem, as the parenchyma continues to be attacked by the mutation — Juan Gurria
3:37Genetic testing is essential before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage — Cecilia Gena
4:09There is no set number of ERCPs that defines when to consider chronic pancreatitis; sooner referral is better for evaluation — Juan Gurria
4:16Surgical pancreatic intervention is not offered unless medical and endoscopic management have been maximized — Juan Gurria
4:31If a stent is placed and the patient continues to have pancreatitis, there is no reason to continue with ERCPs — Juan Gurria
4:37Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT — Cecilia Gena
4:58MRCP is the best non-invasive study for the pancreas, particularly with T2 sequences — Juan Gurria
5:07ERCP is more therapeutic than diagnostic — Juan Gurria
5:11Imaging approach starts with ultrasound, then CT, and MRCP with T2 sequences for better pancreatic anatomy visualization — Cecilia Gena
5:22Pancreatic fluid collections should be drained only if symptomatic once the wall is mature at 4 to 6 weeks — Juan Gurria
5:29Asymptomatic fluid collections without gastric outlet obstruction or pain will self-resolve and do not require drainage — Juan Gurria
5:35Antibiotics are not needed for pancreatic fluid collections — Juan Gurria
5:40Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations — Cecilia Gena
5:50If genetic mutations are confirmed, partial pancreatic resection (Frey procedure) should be avoided to prevent loss of pancreatic cells — Cecilia Gena
6:01If endoscopic approach fails, TPIAT should be considered sooner rather than later — Cecilia Gena

Cases discussed

0:397-year-old with acute recurrent pancreatitis who has undergone 7 ERCPs with stent placement

Points of disagreement

1:28Management approach for the 7-year-old case
- Speaker 5: Would perform Frey procedure (partial head pancreatectomy with duodenal preservation and pancreaticojejunostomy) on this patient
- Juan Gurria: Frey procedure inappropriate if genetic mutation present, as it only temporizes attacks by draining duct without fixing underlying problem, and results in loss of islet cells

Open questions

What is the optimal number of ERCPs before considering surgical referral?
Will medication to mediate trypsin activation in genetic pancreatitis become available in the future?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Written for:

Genetic Pancreatitis in Children: Why the Old Surgical Playbook No Longer Applies

The episode's main topic retold as a plain-language walkthrough — what it is, why it matters, and what the speakers concluded. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Explainer · AI-written, human-reviewed

Why This Exists as a Distinct Problem

Pediatric recurrent pancreatitis was once managed with the same drainage and resection techniques used in adults with chronic pancreatitis from alcohol or gallstones. That approach assumed the problem was mechanical — a strictured duct, a stone, an anatomic variant — and that decompressing the system would stop the attacks. Genetic testing has upended that logic. A significant fraction of children with recurrent pancreatitis carry mutations that drive parenchymal inflammation independent of ductal anatomy 1:57 2:17. The disease is not in the plumbing; it is in the cells themselves. This distinction now determines whether a child benefits from drainage or loses irreplaceable islet mass to a procedure that will not stop the attacks.

The Core Clinical Problem

Recurrent pancreatitis in children is rare, but when it occurs, each attack destroys islet cells 1:40. The traditional surgical response — a Frey procedure or other drainage operation — removes the head of the pancreas to open the duct and decompress the system 3:09. In adults with obstructive chronic pancreatitis, this works. In a child with a PRSS1 mutation, it does not. PRSS1 is a trypsinogen activator that triggers trypsin activation inside the pancreas 1:57. Draining the duct may temporarily reduce attacks by relieving pressure, but the parenchyma continues to be attacked by the mutation 3:19. The child loses islet cells to the operation and then loses more with each subsequent attack. There is currently no medication to block trypsin activation in genetic pancreatitis 2:48.

How the Approach Works

The management sequence now begins with genetic testing, not with escalating endoscopic intervention. Any child with more than one episode of acute pancreatitis, or a single severe episode, should undergo MRCP and a genetic panel 2:26. Cincinnati Children's tests ten genetic markers, including PRSS1, CTRC, CFTR, and CPA1 2:12. The result determines the surgical strategy. If no genetic mutation is found and imaging shows a correctable anatomic problem — a stricture, a stone, a divisum — endoscopic therapy is appropriate. If a genetic mutation is confirmed, drainage procedures are contraindicated 3:37 5:50. The mutation will continue driving attacks regardless of ductal patency, and any resection sacrifices islet mass the patient will need.

Endoscopic management is still first-line when anatomically appropriate 4:16 4:37. ERCP is therapeutic, not diagnostic — the role of MRCP with T2 sequences is to define anatomy non-invasively 4:58 5:07. Imaging begins with ultrasound, advances to CT if needed, and uses MRCP for detailed pancreatic ductal mapping 5:11. If a stent is placed and the patient continues to have pancreatitis, further ERCPs are futile 4:31. Each ERCP carries a risk of post-procedure pancreatitis, and each attack costs islet cells 1:40. There is no set number of ERCPs that defines failure, but sooner referral to a specialized center is better 4:09.

When endoscopic therapy fails in a child with genetic pancreatitis, the definitive option is total pancreatectomy with islet autotransplantation (TPIAT) 4:37 6:01. This removes the inflamed pancreas entirely and reimplants the patient's own islet cells into the liver, where they can function without the inflammatory milieu. The operation is not offered unless medical and endoscopic management have been maximized 4:16, but once that threshold is reached, delay only costs more islet mass.

Where Practice Is Contested

The timing of TPIAT remains a judgment call. No consensus defines how many attacks, how much pain, or how many failed ERCPs justify removing the pancreas. The discussants emphasize earlier referral and earlier consideration of TPIAT once endoscopic options are exhausted 6:01, but the operation is irreversible and the long-term metabolic outcomes are still being defined. The alternative — continuing to lose islet cells with each attack — is also irreversible. The decision rests on predicting which trajectory will leave the patient with better endocrine function at age thirty.

When to Involve This Team

Refer after the second episode of pancreatitis, or after the first severe episode, for genetic testing and MRCP 2:26. Do not wait for multiple failed ERCPs to establish chronicity. If genetic testing is positive, refer to a center that performs TPIAT for evaluation, even if the patient is currently stable. If a stent has been placed and the patient continues to have attacks, transfer rather than repeating endoscopy 4:31 4:37. Surgical pancreatic intervention is not offered until medical and endoscopic options are exhausted, but the evaluation should happen early so the team understands the trajectory.

One practical note: pancreatic fluid collections after an attack should be drained only if symptomatic — causing gastric outlet obstruction or pain — and only after the wall has matured at four to six weeks 5:22. Asymptomatic collections resolve spontaneously and do not require drainage or antibiotics 5:29 5:35. This is conservative management, not neglect.

Takeaways from this story

Genetic testing after the second pancreatitis episode determines whether drainage surgery will help or just sacrifice islet cells.
PRSS1 mutations drive parenchymal attacks independent of ductal anatomy; drainage procedures temporize but do not stop disease.
If a stent is placed and attacks continue, further ERCPs are futile — refer to a TPIAT center rather than repeating endoscopy.
Drain pancreatic fluid collections only if symptomatic after 4-6 weeks; asymptomatic collections resolve without intervention.

Frey Procedure in Pediatric Recurrent Pancreatitis: When Genetic Mutations Change the Calculus

The points where the speakers disagreed, with each position presented side by side. Written by Kai from the episode transcript and reviewed before publishing.

For specialists · Points of disagreement · AI-written, human-reviewed

The Clinical Question

A 7-year-old with seven ERCPs for recurrent pancreatitis presents a decision point familiar to any pancreatic surgeon: when does repeated endoscopic temporizing become futile, and what operation, if any, should follow? The case divided the room. One discussant proposed a Frey procedure — partial head pancreatectomy with duodenal preservation and pancreaticojejunostomy 1:40. Juan Gurria argued against it, contingent on genetic testing results 3:19.

The Case for Frey

The Frey procedure addresses ductal obstruction by removing the anterior pancreatic head and creating a wide drainage anastomosis to a jejunal limb 1:40. The discussant proposing Frey saw seven failed ERCPs as evidence that endoscopic management had reached its limit and that surgical drainage was the logical next step 1:40.

The question posed in response — "What's the downside of that?" — reflects a reasonable surgical instinct: if the duct is obstructed and the patient keeps getting pancreatitis despite stenting, open the duct definitively 1:40.

The Case Against Frey in Genetic Pancreatitis

Gurria's objection rests on the genetic substrate. If this patient carries a PRSS1 mutation — the most common genetic cause in pediatric pancreatitis, a trypsinogen activator that triggers intrapancreatic trypsin activation — the pathophysiology is fundamentally different from obstructive pancreatitis 1:57. The Frey procedure requires removing the top half of the pancreas to expose and drain the duct, which means discarding islet cells 3:09. The discussant noted that with this approach, you discard islet cells 3:09.

More critically, drainage does not address the underlying problem. The patient will likely continue to experience pancreatitis despite ductal drainage because the parenchyma continues to be affected by the mutation 3:19. In genetic pancreatitis, the parenchyma itself is the problem — trypsin activation occurs within acinar cells regardless of ductal patency. A drainage procedure temporizes attacks by decompressing the duct but does not stop the mutation from continuing to injure the gland 3:19. Meanwhile, the operation has cost islet cell mass that will be needed if the patient ultimately requires total pancreatectomy with islet autotransplantation (TPIAT).

Cecilia Gena reinforced this: genetic testing is essential before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage 3:37. If genetic mutations are confirmed, partial pancreatic resection should be avoided to prevent loss of pancreatic cells 5:50.

Where They Agree

Both positions accept that seven ERCPs represent a failure of endoscopic management. Gurria stated that if a stent has been placed and the patient continues to experience pancreatitis, there is no reason to continue with ERCPs 4:31. Neither advocate continuing to repeat the same endoscopic intervention.

Both also agree that surgical intervention should not be offered until medical and endoscopic management have been maximized 4:16. The disagreement is not about whether to operate, but about which operation and in which patients.

Finally, both recognize that every pancreatitis attack and every ERCP carries a cost. Each ERCP carries a risk of post-ERCP pancreatitis, and islet cells are lost with every attack 1:40. The question is how to minimize that cumulative loss.

What Would Resolve It

The discussants identified the resolving factor: genetic testing. Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis 2:12. Patients with more than one episode of acute pancreatitis or a first severe episode should undergo MRCP and genetic panel testing 2:26.

If the panel is negative and imaging shows ductal obstruction, Frey becomes defensible. If PRSS1 or another pathogenic mutation is confirmed, the treatment algorithm shifts: endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT 4:37. TPIAT should be considered sooner rather than later in genetic cases 6:01.

The disagreement, then, is not irresolvable — it reflects different assumptions about the underlying pathophysiology. The genetic result determines which surgical approach, if any, is appropriate. What remains unsettled is the threshold question: at what point in a genetic pancreatitis case does the cumulative islet cell loss from recurrent attacks justify proceeding to TPIAT, even if endoscopic options have not been fully exhausted? The discussants did not address that timing directly.

Takeaways from this story

PRSS1 mutation makes Frey futile—parenchyma keeps getting attacked despite duct drainage, and you've discarded islet cells you'll need for TPIAT
Genetic panel before any resection: avoid losing pancreatic cells in pathologies that won't benefit from drainage procedures
Seven ERCPs with persistent pancreatitis despite stenting means endoscopic management has failed—no reason to continue repeating it
If genetic mutation confirmed and endoscopy fails, transfer to TPIAT center sooner rather than later to preserve remaining islet mass

Genetic Testing Reshapes Surgical Timing in Pediatric Recurrent Pancreatitis

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Teaching arc · AI-written, human-reviewed

Genetic testing precedes any resection decision

The presence of a genetic mutation fundamentally changes what surgery can accomplish. In a patient with PRSS1 — a trypsinogen activator that triggers trypsin inside the pancreas — the parenchyma is under continuous attack regardless of ductal anatomy 1:57. A drainage procedure like the Frey opens the duct by removing the top half of the pancreas, discarding islet cells in the process 3:09. But if the underlying mutation persists, the patient will continue having pancreatitis attacks despite a patent duct 3:19. You have temporized drainage but not addressed the disease mechanism. Genetic testing must occur before any resection to avoid losing pancreatic tissue in a pathology that will not benefit from drainage alone 3:37. Cincinnati's panel tests multiple markers; obtaining this early prevents irreversible loss of endocrine function in patients who need their islet cells preserved for autotransplantation [c3, c4].

Endoscopic therapy has a stopping point

There is no magic number of ERCPs that defines failure, but the principle is clear: if a stent is in place and the patient continues to have pancreatitis, further ERCPs are not indicated 4:31. Each procedure carries a risk of post-ERCP pancreatitis, and each attack costs islet cells 1:40. The question is not how many attempts are reasonable but whether the intervention is addressing the problem. Surgical referral is appropriate once medical and endoscopic options are exhausted — not after an arbitrary procedure count 4:16. Earlier referral to a center performing total pancreatectomy with islet autotransplantation (TPIAT) allows evaluation before further cell loss 4:09. The goal is to maximize what endoscopy can accomplish without prolonging a failing strategy.

MRCP with T2 sequences is the non-invasive standard

MRCP provides the best non-invasive visualization of pancreatic anatomy, particularly with T2 sequences 4:58. The imaging sequence begins with ultrasound, advances to CT, and culminates in MRCP when detailed ductal and parenchymal assessment is needed 5:11. ERCP has shifted from a diagnostic to a therapeutic modality 5:07. Patients with more than one episode of acute pancreatitis — or a single severe episode — warrant MRCP and genetic panel testing 2:26. This combination identifies both anatomic targets for intervention and genetic contraindications to partial resection.

Fluid collections are drained only when symptomatic

Pancreatic fluid collections require a mature wall — four to six weeks — before drainage is considered, and drainage is indicated only if the collection is symptomatic 5:22. Gastric outlet obstruction and pain are the relevant symptoms; asymptomatic collections resolve without intervention 5:29. Antibiotics are not part of the management 5:35. The default posture is observation unless the collection is causing harm. This restraint prevents unnecessary procedures in a disease where each intervention carries risk.

TPIAT is the endpoint when genetic disease is confirmed and endoscopy fails

In a patient with confirmed genetic pancreatitis who continues to have attacks despite maximal endoscopic management, TPIAT should be considered sooner rather than later 6:01. Partial resection procedures like Frey should be avoided when genetic mutations are present, as they sacrifice islet cells without addressing the underlying pathology 5:50. The recurrent pancreatitis population is small, but the consequences of delayed or inappropriate surgery are permanent 5:40. The teaching point is not that TPIAT is common but that it must be considered early in the right patient — before repeated attacks and procedures erode the islet cell mass that autotransplantation depends on.

Takeaways from this story

Obtain genetic testing before any pancreatic resection to avoid losing islet cells in patients whose disease will not respond to drainage.
Stop ERCPs when a stent is placed and pancreatitis continues — further procedures lose islet cells without addressing the underlying problem.
In confirmed genetic pancreatitis unresponsive to endoscopy, refer for TPIAT sooner rather than later to preserve remaining islet cell mass.
Drain pancreatic fluid collections only if symptomatic after wall maturation at 4-6 weeks; asymptomatic collections resolve without intervention.

Keywords

acute recurrent pancreatitis chronic pancreatitis post-ERCP pancreatitis gastric outlet obstruction pancreatic duct stricture ERCP balloon dilation stent placement Frey procedure partial head pancreatectomy pancreaticojejunostomy TPIAT total pancreatectomy with islet autotransplantation MRCP endoscopic ultrasound

Hashtags

#PediatricSurgery #Pancreatitis #GeneticMutations #ERCP #MRCP #TPIAT #IsletCellTransplant #ChronicPancreatitis #EndoscopicUltrasound #FluidCollections #CincinnatiChildrens #PediatricHealth #SurgeryEducation #MedicalResearch #ChildHealth #PancreaticSurgery #HealthCare #SurgicalManagement #PediatricCare #MedicalEducation #PediatricPancreatitis #GeneticTesting

Transcript

Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm Cecilia Gena, a research fellow from Cincinnati Children's Hospital Medical Center. Our 11th annual update course in pediatric surgery was held this past August. In this video, we are going to talk about management of recurrent pancreatitis, and for that we have Doctor Juan Gurria, a pediatric surgeon from Cincinnati Children's Hospital. So first we started with a case. 7 year old with acute recurrent pancreatitis, abdominal pain. It has a diagnosis of ARP referred to you with an ERCP showing a stricture in the head of the pancreas and a dilated duct distally. We've seen this multiple times, um, has had 7 ERCPs and a stent in the past. So, This is the ERCP. So we have a clear stricture in the area of the head of the pancreas and a dilated duct distal and you see clearly the branches. So, what is your plan? MRCP to evaluate for chronic changes, repeat ERCP balloon dilation and stent placement, MRCP and obtain genetics, or admin and plan for FRI procedure? The FR procedure is a partial head pancreatectomy with duodenal preservation and a pancreaticajeinostomy. And it's interesting to see this uh very divided um. MRC so the main is repeat ERCP. So keep doing it. We're 7 ERCPs in. The question is, when do you stop, right? Every time you get an, an ERCP you have a risk of getting post-E ERCP pancreatitis. It's low, right? But it's still a risk, and you lose eyelet cells with every attack. So we're losing cells down the road. And as he said, genetic is key, so it is really important to get a genetic panel. PRSS1 is the most common one, which is a trypsinogen activator. It activates trypsin inside the pancreas. There's CTRC, CFTR, um, you know, CPA1. There's a whole bunch of mutations that we now know. We, our gene, gene panel in Cincinnati runs 10 different genetic, um, uh, markers. So, that's how we're changing the approach to pediatric pancreatitis, chronic pan pancreatitis treatment because of the genetic factors. Awesome. So if a patient has more than 1 episode of acute pancreatitis or a first really bad episode. Of it, we should perform an MRCP and a genetic panel to rule out genetic anomalies. Now you have that patient that has the mutation that they're, they're trypsin activated. What's, how do you mediate that? Is there medication or is there another path that you can do to wonderful question. No, no, there's no, unfortunately we don't have that just yet. That's why I still have a job, but, uh, I hope, I hope some Monday we have, you know. I would do a pow on this kid. What's the downside of that? So, excellent excellent question. If there's a generic mutation, let's say there's a PRSS1 mutation, right? For a pistol, you have to like get the top of, the top half of the pancreas out to open the duct, right? Um, you, you throw, uh, some eyelet cells to the trash. Um, this patient most likely is gonna keep getting pancreatitis despite you draining the duct. The, the parenchyma is gonna keep getting attacked by the mutation. So, you're temporizing um the attack by draining the duct, uh, but you're not fixing the problem. Great, so genetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from a resection and drainage, but instead from an islet cells transplant. So I know the scenario. Pretty much points towards, OK, maybe recurrent or chronic pancreatitis, but after how many do you feel like, OK, this is what we're dealing with? 2, ERCPs, 3, when do you start thinking, considering that this might be a problem? That's a great question. We don't have a set number of ERCPs, so, uh, there's no set limit on that. The sooner the referral, the better for an evaluation. We don't offer, uh, to take care of the pancreas unless you've. Maximize medical and endoscopic management. If there's no other options and your endoscopic guy tells you, you know what, there's nothing for me to balloon dilate, open, drain, or anything. There's been a stent. Even with the stent, the patient keeps getting pancreatitis. There's no reason to keep going with ERCPs. So, do endoscopic treatment at first, but if it fails, transfer to a specialized center that does TPIAT. Or total pancreatectomy with eyelid autotransplantation. Now, what about imaging for these patients? So we use endoscopic ultrasound. An ultrasound and CT scan is imaging of choice once they come. MRCP is the best non-invasive study for pancreas by far, uh, with different uh uh T2 sequences. Um, um, they're great. An ERCP, of course, is more therapeutic than that. Diagnostic. Awesome. Start with ultrasound, then CT and for better see the pancreatic anatomy, MRCP with T2 sequences. Now, what about fluid collections? Once the, the wall is mature in 4 to 6 weeks, uh, if there's symptoms, drain it. If there's no symptoms, don't drain it. If the patient's not having gastric outlet obstruction or pain, there's no need to drain this. Um, it will, it will self resolve, uh, and, of course, there's no need for antibiotics. Also, time to summarize, recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis, and it is associated with genetic mutations. If genetic mutations are confirmed, we should avoid partially resecting pancreatic tissue as in a fright procedure to avoid losing pancreatic cells. The treatment should start with endoscopic approach, keeping in mind that if it fails, a TPI-AT should be considered sooner rather than later. For liquid collection, surgical treatment should be only done if the patient is symptomatic. I hope you enjoyed the video and thank you for watching. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.

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