Tuesday abstract
Tu1989 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) WITH PANCREATIC DUCT (PD) STENT PLACEMENT FOR THE MANAGEMENT OF GRADE 3 OR HIGHER PANCREATIC INJURIES IN CHILDREN WITH BLUNT ABDOMINAL TRAUMA

https://doi.org/10.1016/j.gie.2018.04.2314Get rights and content

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Aim

Pancreatic injury may occur in up to 13% of pediatric patients following blunt abdominal trauma. There is no clear consensus on the management of pancreatic injuries of grade 3 or higher. Laparotomy with distal pancreatectomy is frequently recommended; however pancreatic resection is major abdominal surgery and PD leaks may complicate recovery. Early ERCP with sphincterotomy and pancreatic duct stent placement may allow clinical resolution and reconstitution of the disrupted duct.

Methods

A retrospective review of the endoscopy database was performed to identify pediatric patients who had undergone ERCP in a Children’s hospital by a high volume therapeutic endoscopist for traumatic injuries of the pancreas. The AAST pancreatic organ injury scale was used for grading. Inclusion criteria were age 18 or younger, grade 3 or higher pancreatic injury due to blunt abdominal trauma, no operative management and treatment with one or more ERCPs. Clinical data was abstracted from the

Results

4 patients (75% males, mean age at the time of intervention 10.0 ± 3.3 years) were included. 2 patients (50%) suffered a grade 3 injury and 2 (50%) a grade 4 injury. Mechanisms of injury included bicycle handlebar trauma (50%), fall while running (25%) and collision during a baseball game (25%). 3 patients (75%) had a peri-pancreatic fluid collection. The mean injury severity score was 7.27 ± 7.41, mean number of ERCPs was 2.75 ± 0.95, mean ICU stay was 0.25 ± 0.5 days, mean hospital stay was

Conclusion

In this small series, early ERCP with pancreatic sphincterotomy, wire placement, and PD stenting appeared to be safe and effective. All the children in this series experienced complete clinical resolution of major pancreatic transections with severe Grade 3 injuries and pancreatic duct disruptions without surgery. In centers with availability of complex pediatric therapeutic endoscopy, ERCP may offer a minimally invasive, curative option for pediatric patients with severe blunt trauma injuries

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