Published online Oct 16, 2023. doi: 10.4253/wjge.v15.i10.614
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
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.
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.
To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in treating recurrent pancreatitis due to AAP.
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.
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.
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.
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.