Yang KH, Zeng JQ, Ding S, Zhang TA, Wang WY, Zhang JY, Wang L, Xiao J, Gong B, Deng ZH. Efficacy and safety of endoscopic retrograde cholangiopancreatography in recurrent pancreatitis of pediatric asparaginase-associated pancreatitis. World J Gastrointest Endosc 2023; 15(10): 614-622 [PMID: 37900113 DOI: 10.4253/wjge.v15.i10.614]
Corresponding Author of This Article
Zhao-Hui Deng, PhD, Chief Physician, Department of Gastroenterology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, No. 1678 Dongfang Road, Shanghai 200127, China. dzhrj@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Oct 16, 2023; 15(10): 614-622 Published online Oct 16, 2023. doi: 10.4253/wjge.v15.i10.614
Efficacy and safety of endoscopic retrograde cholangiopancreatography in recurrent pancreatitis of pediatric asparaginase-associated pancreatitis
Kai-Hua Yang, Jing-Qing Zeng, Sheng Ding, Tian-Ao Zhang, Wen-Yu Wang, Jia-Yu Zhang, Lan Wang, Jian Xiao, Biao Gong, Zhao-Hui Deng
Kai-Hua Yang, Jing-Qing Zeng, Sheng Ding, Tian-Ao Zhang, Wen-Yu Wang, Jia-Yu Zhang, Lan Wang, Jian Xiao, Zhao-Hui Deng, Department of Gastroenterology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Biao Gong, Department of Gastroenterology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
Author contributions: Yang KH, Zeng JQ, Ding S contributed equally to this work and share first authorship; Gong B and Deng ZH designed the study; Yang KH, Ding S, Zhang TA, Wang WY, Zhang JY, Wang L, Jian X acquired, analyzed, and interpreted the data; Yang KH and Zeng JQ drafted the manuscript; Deng ZH edited the manuscript; All authors contributed to the article and approved the submitted version.
Supported bythe Science and Technology Commission of Shanghai Municipality of China, No. 22Y11921800.
Institutional review board statement: This study has been approved by the Institutional Ethnic Committee.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: All individual data will shared. The data will be made available from the corresponding author (E-mail: dzhrj@163.com), upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-Hui Deng, PhD, Chief Physician, Department of Gastroenterology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, No. 1678 Dongfang Road, Shanghai 200127, China. dzhrj@163.com
Received: June 19, 2023 Peer-review started: June 19, 2023 First decision: August 11, 2023 Revised: August 26, 2023 Accepted: September 14, 2023 Article in press: September 14, 2023 Published online: October 16, 2023 Processing time: 114 Days and 18.1 Hours
ARTICLE HIGHLIGHTS
Research background
Asparaginase (ASP) is an important drug in combined chemotherapy regimens for pediatric acute lymphoblastic leukemia (ALL); ASP-associated pancreatitis (AAP) is the main adverse reaction of ASP. Recurrent pancreatitis is a complication of AAP, for which medication is ineffective.
Research motivation
As repeated occurrence of AAP limits the application of chemotherapy regimens for ALL, an effective, less invasive, and safe treatment strategy for AAP is desirable.
Research objectives
To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in treating recurrent pancreatitis due to AAP.
Research methods
From May 2018 to August 2021, ten children (five males and five females; age range: 4–13 years) with AAP were treated using ERCP due to recurrent pancreatitis. Clinical data of the ten children were collected, including their sex, age, weight, ALL risk grading, clinical symptoms at the onset of pancreatitis, time from the first pancreatitis onset to ERCP, ERCP operation status, and postoperative complications. The symptomatic relief, weight change, and number of pancreatitis onsets before and after ERCP were compared.
Research results
The preoperative symptoms were abdominal pain, vomiting, inability to eat, weight loss of 2–7 kg, and 2–9 pancreatitis onsets. After the operation, nine of ten patients did not develop pancreatitis, had no abdominal pain, could eat normally; the remaining patient developed three pancreatitis onsets due to continuous administration of ASP, but eating was not affected. The postoperative weight gain was 1.5–8 kg. There was one case of postoperative pancreatitis and two cases of postoperative infections; all recovered after medication.
Research conclusions
ERCP could improve clinical symptoms and reduce the incidence of pancreatitis, and was shown to be a safe and effective method for improving the management of recurrent pancreatitis of AAP.
Research perspectives
Based on our experience of using ERCP in treating recurrent pancreatitis due to AAP, we believe that ERCP can be attempted in children with AAP prior to resuming the use of ASP to ensure that patients can complete their ASP treatment course, thereby improving the event-free survival rate in cases of ALL where children’s ASP therapy is interrupted.
