Acute pancreatitis (AP) in children occurs with an estimated annual incidence of 3–13/100,000 (1, 2). While some children may have a single episode, others may develop acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Children with pancreatic disease can have impacted quality of life due to chronic pain, frequent hospitalizations, and/or nutritional deficiencies. Supportive management is typically indicated for patients with acute pancreatitis, while in some circumstances endoscopic diagnostic evaluation and/or therapy are required. Endoscopy can also be beneficial in patients with ARP or CP (3). Historically, interventional endoscopy procedures which can benefit patients with pancreatitis, such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS), have been performed by adult gastroenterologists with advanced endoscopic training. Adult physicians certainly have adequate training to perform the procedures, but they often lack formal training in caring for pediatric patients or pediatric pancreatitis. Many are employed in facilities that care exclusively for adult patients and either travel to pediatric institutions to perform procedures in an unfamiliar setting or perform procedures for pediatric patients in adult facilities. This approach, when executed well, can be very successful and provide excellent patient care. However, issues can arise utilizing this model due to limited physician availability, timeliness of care and procedures, and challenges in communication amongst pediatric providers, adult proceduralists and families. In an ideal setting, children should be treated at a center with dedicated pediatric nursing staff, anesthesia, behavioral and child life specialists, and pediatric surgical and intensive care expertise if needed (4). Over the last 10–15 years, pediatric gastroenterologists have increasingly pursued training in interventional endoscopy. Pediatric ERCP, EUS, and other advanced endoscopic procedures are now performed safely and effectively in specialized centers by pediatric providers worldwide (5–7). New training opportunities for pediatric gastroenterologists in interventional endoscopy continue to arise (8). In conjunction with advancements in interventional endoscopy, the field of pediatric pancreatology continues to evolve through increased recognition of AP and CP and collaborative approaches to research (9–11). It is increasingly important that providers managing children with pancreatitis are aware of the indications for endoscopic evaluations and interventions for pancreatitis, the benefits and risks involved, and when endoscopic therapy is no longer warranted (3).

https://www.frontiersin.org/articles/10.3389/fped.2022.937136/pdf

Endoscopic Advancements in Pediatric Pancreatitis

In recent years, the usefulness of endoscopic ultrasound (EUS) has been recognized in children. A dedicated pediatric EUS scope has not been developed; in our experience, however, an adult EUS scope can be used. The American Society for Gastrointestinal Endoscopy Technical Committee status assessment report on pediatric endoscopy equipment provides some guidance on the feasibility of EUS according to body size. Careful monitoring is required, keeping in mind potential adverse events such as cervical esophageal perforation and unstable breathing due to tracheal compression. Most devices designed for interventional pancreatobiliary endoscopy are also available for children. Sedation or intubated general anesthesia (GA) is mandatory when performing interventional EUS (I-EUS). I-EUS for children is generally performed using GA in the operating room, but sedation in the endoscopy room is also possible under appropriate monitoring by pediatricians. I-EUS in the operating room is sometimes difficult for endoscopists to perform because of the unsuitable fluoroscopic imaging and the lack of familiar equipment and staff. Compared to GA, sedation in the endoscopy room facilitates easier and quicker repetition of procedures when necessary. Adult pancreatobiliary endoscopists perform most I-EUS procedures in the pediatric population because most pediatric endoscopists have few opportunities to perform EUS-related procedures and thus have difficulty maintaining their skills. To popularize I-EUS techniques for children, it will be necessary to establish a training program for developing pediatric endoscopists. 

Recent progress and current status of pancreatobiliary interventional endoscopic ultrasound in children.

The First Successful Rendezvous Procedure for Pancreatic Duct Drainage in a Pediatric Case With Obstructive Pancreatitis.

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The First Successful Rendezvous Procedure for Pancreatic Duct Drainage in a Pediatric Case With Obstructive Pancreatitis.