A recent retrospective single-center study (TK Lin et al. JPGN 2021; 72: 300-305. Clinical Outcomes Following Therapeutic Endoscopic Retrograde Cholangiopancreatography in Children With Pancreas Divisum) indicated that a minor papilla endoscopic sphicterotomy (mPES) may be beneficial for children with pancreas divisum and pancreatitis. The study included 27 children who had a total of 58 ERCPs.
- After a median follow-up of ~32 months, 13 of 20 responders (65%) reported clinical improvement from endotherapy/mPES.
- A genetic variant was identified in 19/26 (73%) tested patients
- Post-ERCP pancreatitis (PEP) was the only observed adverse event; 21% (12/58)
The authors note that the beneficial finding of improvement after mPES in children is contrary to findings in adults. In addition, there is an active sham-controlled randomized clinical trial ongoing in adults (NCT03609944). They speculate that this could be related to longer disease burden in adults. In addition, they note that their findings had limitations:
- this was a retrospective study with a small sample size
- the results were based on a subjective non-validated questionnaire with concerns for recall bias
My take: I am not convinced that sphincterotomy is beneficial in most children with pancreatitis and pancreas divisum –the majority of whom have an underlying genetic variant which likely triggers pancreatitis. The only way to answer this question definitely is to perform a randomized clinical trial similar to the sham-controlled study in adults.
Related blog posts:
- Does pancreas divisum cause pancreatitis?
- Imaging Recommendations for Pediatric Pancreatitis
- Consensus Pancreatitis Recommendations | gutsandgrowth
- Chronic Pancreatitis in Pediatrics -Descriptive Study | gutsandgrowth
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.