Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5718
Peer-review started: May 31, 2020
First decision: June 18, 2020
Revised: July 1, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: October 7, 2020
Pancreaticopleural fistula (PPF) is a rare disease, especially in children. Conservative treatment and surgery are traditional therapies, but surgery is invasive. The emergence of endoscopic retrograde cholangiopancreatography (ERCP) has provided a new noninvasive treatment for PPF and may become the first choice for children with PPF.
To explore the treatment response to ERCP for PPF in children.
Seven children with PPF were hospitalized in the Gastroenterology Department of Beijing Children’s Hospital from December 2007 to May 2019. Data on these seven patients’ clinical characteristics, diagnosis, treatments, and outcomes were analyzed, and their treatment responses following surgery and ERCP were compared. The correlation between the length of hospital stay and conservative treatment was analyzed. Peer-reviewed articles written in English and Chinese published from January 2009 to December 2019 were obtained from various open data sources and reviewed.
The seven patients comprised three boys and four girls with a mean age of 6.57 ± 3.26 years. The main symptoms were chest tightness and pain (n = 4), intermittent fever (n = 3), dyspnea (n = 3), and abdominal pain (n = 1), and all patients had bloody pleural effusion. All seven patients were diagnosed with PPF by magnetic resonance cholangiopancreatography, and all were initially treated conservatively for a mean of 34.67 ± 22.03 d with a poor response. Among five patients who underwent ERCP, one required surgery because of intubation failure; thus, the success rate of ERCP was 80%. Two patients were successfully treated with surgery (100%). The postoperative hospital stay of the two patients treated by surgery was 20 and 30 d, respectively (mean of 25 d), and that of the four patients treated by ERCP ranged from 12 to 30 d (mean of 19.25 ± 8.85 d). The recovery time after ERCP was short [time to oral feeding, 4-6 d (mean, 5.33 ± 1.15 d); duration of closed thoracic drainage, 2-22 d (mean, 13.3 d)]. Analysis of previous cases of PPF published worldwide during the past decade showed that the treatment success rate of ERCP is not lower than that of surgery. There was no significant difference in the postoperative hospital stay between surgery (16 ± 10.95 d) and ERCP (18.7 ± 6.88 d, P > 0.05). A positive linear correlation was found between the overall hospital stay and ERCP intervention time (R2 = 0.9992).
ERCP is recommended as the first-choice treatment for PPF in children. ERCP should be performed as early as possible if conditions permit.
Core Tip: Data on the clinical characteristics, diagnosis, treatments, and outcomes of seven Chinese children with pancreaticopleural fistula (PPF) were analyzed and compared with those described in previous publications of children and adults with PPF worldwide. There was no significant difference in the postoperative hospital stays between surgical treatment (17.2 ± 11.9 d) and endoscopic retrograde cholangiopancreatography (ERCP) (20.75 ± 5.78 d). However, there was a positive linear correlation between the overall hospital stay and ERCP intervention time (R2 = 0.9992). Therefore, ERCP is recommended as the first-choice treatment of PPF in children. ERCP should be performed as early as possible if conditions permit.