How We Help Pediatric Gastroenterologists

Pediatric Gastroenterologists

Problem:

“The diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of this is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not been specifically described.” (Randall, McDaniels, et al). Many cases of acute pancreatitis occur in children who have a separate illness.
While there is no single test to diagnose pancreatitis, the diagnosis is clinical and depends on the presence of symptoms consistent with acute pancreatitis, abnormal blood tests, or radiographic images showing inflammation in the pancreas.
There remains a need for a sensitive and accurate test to be performed in a pediatric population for diagnosing exocrine pancreatic insufficiency and disease.

Solution

Secretin Stimulated Endoscopic Pancreatic Function Test
ePFT is now preferred due to relative technical ease, shorter duration, and comparable efficacy. Pediatric-specific considerations include the potential need for age-specific interpretation, especially for infants and toddlers, as a result of enzyme maturation occurring throughout the early years of life.
The ePFT can be a valuable test for EPI to complement the use of non-stimulatory pancreatic function tests. It is a safe procedure that can be performed when routine EGD is performed for investigation of children suspected of having pancreatic exocrine dysfunction.

Sample Collection

NOTE: Atropine use should be avoided before sample collections

Step 1:

Give Secretin 0.2 mcg/kg as IV push over 30 to 60 seconds as soon as the endoscope is intubated into the esophagus.

Step 2:

Aspirate all gastric fluid through the endoscope channel and discard; Advance endoscope into the duodenum.

Step 3:

Insert suction catheter (see Kimberly-Clark reference material below) and have it positioned at level or below the ampulla, then open the channels.

Step 4:

Add Luken’s Trap Specimen Container to the suction tubing circuit as it comes out of the light source.

Step 5:

Suction the fluid using standard suction pressure; Some blood may be suctioned, but this does not adversely affect the test.

Step 6:

Release suction and move the catheter to different positions if needed.

Step 7:

Collect stimulated duodenal fluid into a syringe through the suction catheter until 0.5 to 1 ml is collected (usually within 2-3 minutes) (Specimen #1).

Step 8:

Remove the collecting chamber of the Luken’s Trap Specimen Container and transfer fluid into collection tubes.

Step 9:

Collect additional fractions within 2 to 3 minutes, or until 0.5 to 1 ml is collected. (Specimens #2, #3, and #4).

Step 10:

Place collection tubes on ice as soon as collected.

Step 11:

Ship samples on dry ice.

Step 12:

Insert completed requisition form with samples to be shipped.

Refer to the requisition form for shipping information. To set up account and reporting results, and for any questions regarding tests or sample shipping, please call 321-841-7820.

KIMBERLY-CLARK
KIMBERLY-CLARK* Aspiration Catheters are designed for gentle aspiration of the duodenal fluid and facilitate collection and evaluation of the cholesterol crystal content of the biliary drainage.

Rounded, sealed catheter tip | Slit lateral openings with suction area | Disposable | Non-Sterile

Source: Endoscopic Pancreatic Function Testing (ePFT) in Children: A Position Paper From the NASPGHAN Pancreas Committee – PubMed (nih.gov)

Arnold Palmer Hospital for Children | Orlando Health

Endoscopic Pancreatic Function Testing (ePFT) in Children: A Position Paper From the NASPGHAN Pancreas Committee

Endoscopic Pancreatic Function Testing (ePFT) in Children: A… : Journal of Pediatric Gastroenterology and Nutrition (lww.com

Chronic Pancreatitis in Children – National Pancreas Foundation

Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department | BMC Emergency Medicine | Full Text (biomedcentral.com)