Impact of EUS-Guided FNA in Management of Children with Idiopathic Fibrosing Pancreatitis (IFP)

Document Type

Article

Publication Date

4-2009

Abstract

Background:

IFP is a rare cause of chronic pancreatitis in children. Diagnosis is usually established by surgical biopsy and most children are managed by surgical biliary bypass. Aim: Evaluate the role of EUS-guided fine needle aspiration (EUS-FNA) in diagnosis of IFP and its impact on management.

Methods:

Four children were referred for EUS over a 3-yr period for evaluation of obstructive jaundice of unclear etiology. A CT of the abdomen revealed a pancreatic mass with biliary ductal dilation in all 4 children; none of them had cholelithiasis or choledocholithiasis. All children underwent EUS using the linear echoendoscope and a FNA of the pancreas was undertaken. Chronic pancreatitis (CP) was graded based on standard EUS criteria (4/9 criteria diagnostic of chronic pancreatitis). ERCP was then performed for endobiliary stenting if a distal CBD stricture was noted at EUS. EUS was considered to have a positive impact if a definitive diagnosis was established and if the findings precluded a need for surgery.

Results:

At EUS, the pancreas was uniformly hypoechoic with a ‘sausage’ shaped appearance of the gland in the head region in all 4 children (3 boys; mean age 14.2 yrs [range, 11-18]). All children met 4 (foci, stranding, lobulation and irregular main pancreatic duct) of 9 criteria for CP. At FNA, parenchymal fibrosis was documented in all children. Two of 4 children had a distal CBD stricture and underwent endobiliary stenting (10Fr stent) at ERCP; in 2 others the jaundice was resolving and the distal CBD was unremarkable. Multiple 10Fr stents were deployed in the 2 children over a mean duration of 6-months for sequential dilation of the stricture. At completion of 6-month treatment, there was no residual stricture in both children. At a mean follow-up of 480 days (range, 398-1290) all 4 children were doing well without any symptom recurrence. EUS had a positive impact on all 4 children by establishing a definitive diagnosis and precluding the need for surgery (for diagnosis or therapy).

Conclusions:

EUS-guided FNA is a minimally invasive, safe and accurate technique for diagnosis of idiopathic fibrosing pancreatitis in children. By establishing a definitive diagnosis it precludes the need for a surgical biopsy or biliary bypass procedure.

DOI

10.1016/j.gie.2009.03.319

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