TY - JOUR
T1 - Specialized imaging and procedures in pediatric Pancreatology
T2 - A north American society for pediatric gastroenterology, Hepatology, and nutrition clinical report
AU - Lin, Tom K.
AU - Troendle, David M.
AU - Wallihan, Daniel B.
AU - Barth, Bradley
AU - Fox, Victor L.
AU - Fishman, Douglas S.
AU - Morinville, Veronique D.
N1 - Publisher Copyright:
Copyright © 2016 by European Society for Pediatric Gastroenterology.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Objectives: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. Methods: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: Transabdominal ultrasonography (TUS), computed tomography (CT),magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified. Results: TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures. Conclusions: Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
AB - Objectives: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. Methods: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: Transabdominal ultrasonography (TUS), computed tomography (CT),magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified. Results: TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures. Conclusions: Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
KW - computed tomography
KW - endoscopic retrograde cholangiopancreatography
KW - magnetic resonance cholangiopancreatography
KW - pancreas
KW - pediatrics
KW - transabdominal and endoscopic ultrasonography
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U2 - 10.1097/MPG.0000000000001371
DO - 10.1097/MPG.0000000000001371
M3 - Article
C2 - 28230608
AN - SCOPUS:84981216441
SN - 0277-2116
VL - 64
SP - 472
EP - 484
JO - Journal of pediatric gastroenterology and nutrition
JF - Journal of pediatric gastroenterology and nutrition
IS - 3
ER -