Functional Pancreatic Sphincter Dysfunction in Children: Recommendations for Diagnosis and Management

Tom K Lin; Douglas S Fishman; Matthew J Giefer; Quin Y Liu; David Troendle; Steven Werlin; Mark E Lowe; Aliye Uc

doi:10.1097/MPG.0000000000002515

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Functional Pancreatic Sphincter Dysfunction in Children: Recommendations for Diagnosis and Management

Journal article

Peer reviewed

Functional Pancreatic Sphincter Dysfunction in Children: Recommendations for Diagnosis and Management

Tom K Lin, Douglas S Fishman, Matthew J Giefer, Quin Y Liu, David Troendle, Steven Werlin, Mark E Lowe and Aliye Uc

Journal of pediatric gastroenterology and nutrition, Vol.69(6), pp.704-709

12/2019

DOI: 10.1097/MPG.0000000000002515

PMCID: PMC6878194

PMID: 31567892

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https://www.ncbi.nlm.nih.gov/pmc/articles/6878194View

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Abstract

Functional pancreatic sphincter dysfunction (FPSD), previously characterized as pancreatic sphincter of Oddi dysfunction, is a rarely described cause of pancreatitis. Most studies are reported in adults with alcohol or smoking as confounders, which are uncommon risk factors in children. There are no tests to reliably diagnose FPSD in pediatrics and it is unclear to what degree this disorder contributes to childhood pancreatitis. We conducted a literature review of the diagnostic and treatment approaches for FPSD, including unique challenges applicable to pediatrics. We identified best practices in the management of children with suspected FPSD and formed a consensus expert opinion. In children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), we recommend that other risk factors, specifically obstructive factors, be ruled out before considering FPSD as the underlying etiology. In children with ARP/CP, FPSD may be the etiology behind a persistently dilated pancreatic duct in the absence of an alternative obstructive process. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be considered in a select group of children with ARP/CP when FPSD is highly suspected and other etiologies have been effectively ruled out. The family and patient should be thoroughly counseled regarding the risks and advantages of endoscopic intervention. Endoscopic retrograde cholangiopancreatography for suspected FPSD should be considered with caution in children with ARP/CP when pancreatic ductal dilatation is absent. Our consensus expert guidelines provide a uniform approach to the diagnosis and treatment of pediatric FPSD. Further research is necessary to determine the full contribution of FPSD to pediatric pancreatitis.

Child

Humans

Pancreatitis - etiology

Practice Guidelines as Topic

Sphincter of Oddi Dysfunction - complications

Sphincter of Oddi Dysfunction - diagnosis

Sphincter of Oddi Dysfunction - physiopathology

Sphincter of Oddi Dysfunction - therapy

Details

Title: Subtitle: Functional Pancreatic Sphincter Dysfunction in Children: Recommendations for Diagnosis and Management
Creators: Tom K Lin - Cincinnati Children's Hospital Medical Center
Douglas S Fishman - Baylor College of Medicine
Matthew J Giefer - Seattle Children's Hospital
Quin Y Liu - Cedars-Sinai Medical Center
David Troendle - The University of Texas Southwestern Medical Center
Steven Werlin - Medical College of Wisconsin
Mark E Lowe - Washington University in St. Louis
Aliye Uc - University of Iowa
Resource Type: Journal article
Publication Details: Journal of pediatric gastroenterology and nutrition, Vol.69(6), pp.704-709
DOI: 10.1097/MPG.0000000000002515
PMID: 31567892
PMCID: PMC6878194
NLM abbreviation: J Pediatr Gastroenterol Nutr
ISSN: 0277-2116
eISSN: 1536-4801
Grant note: R01 DK118752 / NIDDK NIH HHS R24 DK096518 / NIDDK NIH HHS U01 DK108334 / NIDDK NIH HHS R21 DK096327 / NIDDK NIH HHS P30 DK054759 / NIDDK NIH HHS
Language: English
Date published: 12/2019
Academic Unit: Stead Family Department of Pediatrics; Radiation Oncology; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9984312964502771

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