Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

Table 1 Laboratory findings in patients with pancreaticopleural fistula

Patients	Appearance of pleural effusion	Leukocyte count of pleural fluid (× 106 L)	Pleural effusion protein (g/L)	Pleural amylase (U/L)	Serum amylase (U/L)	Blood lipase (U/L)	Ascites amylase (U/L)
1	Bloody	300	40.0	6625	1026	3912.9	13053.0
2	Bloody	560	34.0	10477	423	1051	-
3	Bloody	3600	40	3178	409	950	-
4	Bloody	1700	17.4	50465	284-654	355.4	-
5	Bloody	800	45	1584	110	4470	-
6	Bloody	1200	27.6	65000	1368	1312.2
7	Bloody	6	46.7	25549	738	731.2	-

Table 2 Clinical symptoms, treatments, and outcomes of seven children with pancreaticopleural fistula

Patients	1	2	3	4	5	6	7
Age (yr)	8	10	3	2	5	8	10
Gender	Male	Female	Male	Male	Female	Female	Female
Symptom	Fatigue, poor appetite, intermittent fever, abdominal distention	Intermittent chest tightness and upper abdominal pain	Chronic pancreatitis, recurrent abdominal pain	Wheezing, shortness of breath, repeated bloody pleural effusion	Abdominal pain for half a year, fever and chest tightness	Intermittent chest tightness and dyspnea for more than 20 d	Chest pain with dyspnea
Etiology	Suspected trauma and pseudocyst	Dilatation and calculus of pancreatic duct	Congenital pancreatic duct dysplasia and pseudocyst	Pseudocyst and dilatation of pancreatic duct	Pseudocyst and dilatation of pancreatic duct	Dilatation and calculus of pancreatic duct	Pancreatic duct stone, pseudocyst, dilatation of pancreatic duct
Diagnosis	laboratory examination, B ultrasound, MRCP	laboratory examination, MRCP	laboratory examination, enhanced CT, MRC, ERCP	laboratory examination, CT, B ultrasound, MRCP	laboratory examination, CT, B ultrasound, MRCP	laboratory examination, CT, MRCP, ERCP	laboratory examination, CT, B ultrasound, MRCP
Location of pleural effusion	Right	Bilateral	Bilateral	Left	Right	Bilateral	Right
Amylase in pleural effusion (U/L)	6625	10477	3178	50465	1584	65000	25549
Conservative treatment time (d)	10	21	60	24	19	20	10
ERCP treatment	Yes (Surgical treatment after ERCP failure)	No (Operation)	Yes	Yes	No (Operation)	Yes	Yes
Serum amylase concentration before operation (U/L)	889.4	153	367	429	93.0	292	283
Serum amylase concentration after operation (U/L)	102		267	315		105	110
Time for amylase to return to normal (Days after operation)			23	10		9	4
Lipase concentration before operation/ERCP (U/L)	567	1051		355.4	115	106	731.2
Lipase concentration after operation/ERCP (U/L)						51.7	62.4
Stop somatostatin pump maintenance time (days after operation)			19	5		3	4
Postoperative recovery time of eating (days after operation)	3	3	6	6		4	15
Times of fever treated conservatively	1	3	5	3	4		Normal temperature
Chest closed drainage time (days after operation)	-	-	16	-	-		-
Postoperative hospital stay (d)	20	30	30	12		12	23
Total length of stay (d)	30	52	90	36		32	33

CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography.

Table 3 Comparison of therapeutic effect of endoscopic retrograde cholangiopancreatography vs conservative treatment

Patients	Conservative treatment time (d)	Recovery time of indexes after ERCP (d)				Serum amylase concentration (U/L)		Hospital stay after different treatment (d)		Total length of stay (d)
		Postoperative discharge	Somatostatin pump maintenance	Recovery time of eating	Blood amylase recovery	2 d before operation	2 d after operation	Operation	ERCP
12	10							20		30
22	21							31		52
52	19	-
33	60	30	19	6	23	367	292		30	90
43	24	12	5	6	10	267	249		12	36
63	20	12	3	4	9	429	283		12	32
71,3	10	23	4	15	4	315	110-		23	33
Average (ERCP)	34.67 ± 22.03	18 ± 10.39	9 ± 8.72	5.33 ± 1.15	14 ± 7.81	344.5 ± 69.58	233.5 ± 84.39	25.5 ± 7.78	18 ± 10.39	-

¹The second day after endoscopic retrograde cholangiopancreatography (ERCP) stent placement, the patient had poor drainage of the pancreatic stent outflow tract because of stone blockage. This made it difficult to control the secondary infection, and the hospitalization time was prolonged. This patient was not included in the statistical analysis.

²Surgical treatment.

³ERCP treatment. ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 Worldwide cases of pancreaticopleural fistula published in the most recent 10 years

Publication years	Gender/age (yr)	Diagnosis	Treatments	Conservative treatment time (d)	Postoperative hospital stays (d)
					Operation	ERCP
Adult
2009[6]	F/52	CT/MRCP	Conservative/ERCP	14		7
2009[6]	M/46	MRCP	Conservative/ERCP	27		14
2010[7]	F/44	CT	Conservative/operation		5
2012[8]	M/64	B ultrasound/ERCP	Conservative/ERCP
2012[9]	F/52	CT	Conservative/operation
2012[10]	M/58	CT/ERCP	Conservative/operation	42
2013[11]	F/47	CT	Conservative
2013[12]	M/59	CT/ERCP	Conservative	56
2013[13]	F/58	CT/MRI	Conservative/ERCP	7		12
2016[14]	F/65	CT/MRCP	Conservative/operation		21
2014[15]	F/50	CT/MRCP	Conservative/ERCP/operation
2014[16]	M/49	CT/MRCP/MRI	Conservative/operation
2015[17]	M/43	CT/ERCP	Conservative/operation	35	10
2015[18]	M/43	CT/MRCP	Conservative/ERCP/operation	28
2016[19]	M/58	CT	Conservative/ERCP
2016[20]	M/51	CT/ERCP/MRI	ERCP	21
2016[21]	F/51	CT/MRCP	Conservative/operation	28	5
2016[22]	F/63	CT/MRCP	Conservative/operation		30
2016[23]	M/78	CT	Conservative
2017[24]	M/44	MRCP	Conservative/ERCP
2017[25]	M/52	CT/MRCP	Conservative
2018[26]	M/49	CT/MRCP/ERCP	Conservative/ERCP
2019[27]	M/52	Operation	Conservative/ERCP			21
2019[28]	M/35	CT	Conservative/ERCP	14		20
2019[29]	M/65	CT/MRCP/ERCP	Conservative/operation
Children
2009[30]	M/4	CT/MRCP	Conservative/ERCP	60		30
2013[31]	F/5	CT	Conservative	50
2013[32]	M/15	CT/MRI	Conservative/ERCP			28
2014[33]	M/2.5	B ultrasound/CT	Conservative/operation	26	11
2014[34]	M/8	CT	Conservative	60
2014[34]	M/2	CT	Conservative
2016[35]	M/2	CT	operation
2018[36]	F/8	CT/MRCP	Conservative/ERCP	17		19
2018[37]	F/14	CT/MRCP	Conservative/operation		30
2019[38]	M/3	CT/MRCP	Conservative/ERCP			18
2019[39]	F/8	CT/MRCP	Conservative/ERCP	8		18
2019[40]	M/14	CT	Conservative/operation	30
AVG				30.76 ± 17.4	16 ± 10.95	18.7 ± 6.88
P value					P > 0.05

CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography; MRI: Magnetic resonance imaging.