内镜逆行胰胆管造影术治疗儿童门冬酰胺酶相关胰腺炎的有效性及安全性

Efficacy and safety of endoscopic retrograde cholangiopancreatography for pediatric patients with asparaginase‑associated pancreatitis

摘要:

目的 初步探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）治疗儿童门冬酰胺酶相关胰腺炎（asparaginase‑associated pancreatitis， AAP）后复发性急性胰腺炎及顽固性胰腺假性囊肿的有效性和安全性。方法 回顾性分析2018年11月至2024年7月因AAP后复发性急性胰腺炎及顽固性胰腺假性囊肿于上海儿童医学中心接受ERCP治疗的19例患儿的临床资料，包括ERCP操作情况、并发症发生情况，并比较ERCP干预前后假性囊肿大小、胰腺炎发作次数以及体重指数（body mass index，BMI）。结果 19例患儿共行30例次ERCP操作，操作成功率96.7%（29/30）。13例复发性急性胰腺炎患儿中，11例术后无再发胰腺炎；1例患儿应用门冬酰胺酶后仍有急性轻症胰腺炎发作3次，但腹痛程度及持续时间较ERCP术前胰腺炎发作时减轻或减少，经药物治疗后治愈；1例患儿暴饮暴食后出现急性轻症胰腺炎发作1次，药物治疗后治愈。12例假性囊肿患儿中，8例患儿术后假性囊肿消失，4例患儿假性囊肿显著变小。术后所有患儿BMI较术前有不同程度的升高。共发生ERCP并发症10例次，其中ERCP术后胰腺炎、术后感染各5例次，高淀粉酶血症2例次，术后出血1例次，有2例次同时发生ERCP术后胰腺炎、术后感染，1例次同时发生ERCP术后胰腺炎、术后出血，经保守治疗均治愈。结论 AAP患儿出现复发性急性胰腺炎和顽固性胰腺假性囊肿时，ERCP治疗干预安全、有效。

Abstract:

Objective To preliminarily investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for recurrent acute pancreatitis and refractory pancreatic pseudocysts following asparaginase‑associated pancreatitis (AAP) in children. Methods A retrospective analysis was conducted on the clinical data of 19 pediatric patients who underwent ERCP for recurrent aute pancreatitis and refractory pancreatic pseudocysts following AAP at Shanghai Children''s Medical Center between November 2018 and July 2024. Data primarily included ERCP procedure outcomes, ERCP‑related complications. Pseudocyst size, frequency of pancreatitis episodes, and body mass index (BMI) before and after the ERCP intervention were compared. Results A total of 30 ERCP procedures were performed in 19 children, with a technical success rate of 96.7% (29/30). Among the 13 children with recurrent acute pancreatitis, 11 remained symptom‑free post‑ERCP. One clild experienced 3 further episodes of acute mild pancreatitis following asparaginase administration, though the severity and duration of abdominal pain were reduced compared with pre‑ERCP episodes. Another child developed 1 episode of aute mild pancreatitis after overeating. Both of them were resolved following medical treatment. Of the 12 children with pancreatic pseudocysts, complete resolution was observed in 8 cases, and significant reduction in size was achieved in 4 cases. All patients showed an increase in BMI postoperatively. A total of 10 procedure‑related adverse events occurred, includings 5 post‑ERCP pancreatitis (PEP), 5 postoperative infection, 2 hyperamylasemia, and 1 postoperative bleeding. Co‑occurrence of PEP and infection was noted in 2 procedures, and PEP with bleeding in 1 procedure. All complications were managed successfully with conservative treatment. Conclusion ERCP demonstrates favorable efficacy and acceptable safety for managing recurrent acute pancreatitis and refractory pancreatic pseudocysts following AAP in children.