Fatma DEMİRBAŞ, Mustafa KAYMAZLI, Gönül DİNLER ÇALTEPE, Esra EREN, Ayhan Gazi KALAYCI, Ahmet BEKTAŞ

Pediatrik hastalarda kronik pankreatit ve endoskopik ultrasonografi arasındaki ilişkinin değerlendirilmesi

Pediatrik kronik / tekrarlayan pankreatitte (KP / TP) endoskopik ultrasonografinin (EUS) rolüne ilişkin veriler sınırlıdır. Bu çalışmanın amacı, çocukluk çağında RP'nin tanı ve klinik gözleminde EUS'nin rolünü değerlendirmektir. Eylül 2016 ve Eylül 2017 tarihleri arasında TP'li 17 hastanın ve kontrol grubundaki 20 hastanın EUS bulguları retrospektif olarak değerlendirildi ve bulgular karşılaştırıldı. Kontrol grubu kolestolitiyazis nedeniyle EUS uygulanan ancak pankreatiti olmayan hastalardan oluşmaktaydı. En sık EUS bulgusu hastaların 15'inde (% 88,2) ≥3 mm hiperekoik banttı. Konvansiyonel kriterlere göre 11 hastada (% 64,7) ≥3 patolojik bulgu bulundu. Hiçbir hasta, CP'nin kesin tanısı için Rosemont kriterlerini karşılamadı. Pankreatit olgularının EUS bulgularının kontrol grubuyla karşılaştırıldığında, ≥3 mm hiperekoik bantlar, lobülarite, kanal dilatasyonu ve hiperekoik kanal marjı istatistiksel olarak anlamlı düzeyde olduğu saptandı (p <0,001, p = 0,004, p = 0,009, p<0,001,sırasıyla). Bu çalışmada hiperekoik çizgi çocukluk çağında pankreatitin en sık EUS bulgusudur. Pediyatrik hastalarda CP tanısı için EUS kriterlerinin eşik sayısı belirsizdir. Bununla birlikte, bizim görüşümüze göre, konvansiyonel kriterler, çocuklukta KP tanısı için Rosemont kriterlerinden daha uygundur. Bu alanda daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler:

çocuk, Endoskopik ultrosonografi

Evaluation of the relationship between chronic pancreatitis and endoscopic ultrasonography in pediatric patients

Data regarding the role of endoscopic ultrasonography (EUS) in pediatric chronic/ recurrent pancreatitis (CP/RP) is limited. The aim of this study is to evaluate the role of EUS in the diagnosis and clinical observation of RP in childhood. Between September 2016 and September 2017 EUS findings of 17 patients with RP and 20 patients in a control group were evaluated retrospectively, and the findings were compared. The control group consisted of patients who underwent EUS for cholecystolithiasis but had no pancreatitis. The most common EUS finding was ≥3 mm hyperechoic strands in 15 (88.2%) of the patients. According to the Conventional criteria, 11 patients (64.7%) had pathological findings ≥3. No patient in this study fulfilled the Rosemont criteria for the definitive diagnosis of CP. In the comparison of the EUS findings of the pancreatitis cases to the control group, hyperechoic strands ≥3mm in the pancreatic parenchyma (p<0.001), lobularity (p=0.004), duct dilatation (p= 0.009) and hyperechoic duct margin (p<0.001) were determined to have statistically significant differences. In this study, hyperechoic line is the most common EUS finding of pancreatitis in childhood. The threshold number of EUS criteria for the diagnosis of CP in pediatric patients is unclear. However, in our opinion, the Conventional criteria are more suitable than the Rosemont criteria for the diagnosis of CP in childhood. Further studies are needed in this field.

Keywords:

Child, Endoscopic ultrasonography,

PDF

___

References 1. Cheryl E Gariepy, Melvin B. Heyman, Mark E. Lowe et al. The Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group. J Pediatr Gastroenterol Nutr 2017; 64: 95–103. 2. Adzick NS. The pancreas. In: Coran AG, Adzick NS, T.M K, et al.,eds. Pediatric Surgery 2012;1371–1384 3. Darge K, Anupindi S. Pancreatitis and the role of US, MRCP and ERCP. Pediatr Radiol 2009; 39:153-157. 4. Sivak MV, Kaufman A. Endoscopic ultrasonography in the differential diagnosis of pancreatic disease. A preliminary report. Scand J Gastroenterol Suppl 1986; 39: 153-7 5. Stevens T. Update on the role of endoscopic ultrasound in chronic pancreatitis. Curr Gastroenterol Rep 2011; 13: 117–122. 6. Seicean A. Endoscopic ultrasound in chronic pancreatitis: where are we now? World J Gastroenterol 2010; 16: 4253–4263. 7. Wiersema MJ, Hawes RH, Lehman GA, Kochman ML, Sherman S, Kopecky KK. Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 1993: 25: 555–564. 8. Buscail L, Escourrou J, Moreau J, et al. Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP. Pancreas 1995; 10: 215–217. 9. Sahai AV, Zimmerman M, Aabakken L, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc1998; 48: 18–25. 10. Catalano MF, Lahotu S, Geenen JE Hogan WJ. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 1998; 48: 11–17. 11. Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc 2002; 55: 507–511. 12. Rickes S, Uhle C, Kahl S, et al. Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis. Gut 2006; 55:74–78. 13. Varadarajulu S, Wilcox CM, Eloubeidi MA. Impact of eus in the evaluation of pancreaticobiliary disorders in children. Gastrointest Endosc2005; 62: 239-244. 14. Gordon K, Conway J, Evans J, Petty J, Fortunato JE, Mishra G. Eus and Eus-guided interventions alter clinical management in children with digestive diseases. J Pediatr Gastroenterol Nutr 2016; 63: 242-2466. 15. Morinville VD, Husain SZ, Bai H, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012; 55:261. 16. Kalmin B, Hoffman B, Hawes R, Romagnuolo J. Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: comparing interobserver reliability and intertest agreement. Can J Gastroenterol 2011;25:261-4 17. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009; 69: 1251-61. 18. A Parniczky A Maisam Haija A-E, Husain S, et al. EPC/HPSG evidence-based guidelines for the management of pediatric Pancreatitis. Pancreatology 2018; 18:146-160. 19. Gardner TB, Levy MJ. EUS diagnosis of chronic pancreatitis. Gastrointest Endosc 2010;71:1280–1289 20. Morris-Stiff G, Webster P, Frost B, Lewis WG, Puntis MC, Roberts SA Endoscopic ultrasound reliably identifies chronic pancreatitis when other imaging modalities have been non -diagnostic. JOP 2009; 10:280–283. 21. Singh SK, Srivastava A, Rai P, Yachha SK, Poddar U. Yield of Endoscopic Ultrasound in Children and Adolescent With Acute Recurrent Pancreatitis. J Pediatr Gastroenterol Nutr 2018; 66: 461-465. 22. Scheers I, Ergun M, Aouattah T, et al. Diagnostic and Therapeutic Roles of Endoscopic Ultrasound in Pediatric Pancreaticobiliary Disorders. J Pediatr Gastroenterol Nutr 2015; 61:238–247