BACKGROUND: Transabdominal ultrasound (TAUS) is frequently utilized in pediatric acute pancreatitis for its ready availability, low cost, and lack of ionizing radiation or need for anesthesia. Its utilization in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) is not well described despite recommendations suggesting its use in serial monitoring of ARP if sedation for other imaging studies is required. Our aim was to describe TAUS utilization and findings from the largest multicenter cohort of pediatric ARP and CP, the International Study Group of Pediatric Pancreatitis: In Search for a CuRE-2 (INSPPIRE-2).
METHODS: All patients with available TAUS imaging data from this multicenter prospective cohort study were included. Imaging dates and findings as reported on physician questionnaires were utilized, including results of computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), and endoscopic retrograde pancreatography (ERCP) studies. TAUS utilization and findings were compared between ARP and CP groups. Kappa statistics were used to compare agreement of TAUS findings to other imaging modalities within +/-6 months of every US, as well as within +/-3 months of TAUS studies obtained near CP diagnosis.
RESULTS: 828 patients from INSPPIRE-2 had TAUS (439 ARP, 389 CP). Mean number of TAUS per patient was higher in CP patients than ARP (4.7 vs 3.4, P = <0.001); mean number per year was similar between groups (0.89 vs 0.87, P=0.72). Per episode of acute pancreatitis, CP patients had more TAUS (1.2 vs 1.0, P=0.04). In the agreement analysis, TAUS and CT demonstrated the most consistent agreement for categorical findings amongst other modalities with kappa values ranging from 0-0.64 with good agreement for calcifications/intraductal stones (k=0.64) and pancreatic duct (PD) irregularities (k=0.61). Agreement between MRI/ERCP/EUS and TAUS was generally lower. Near the date of CP diagnosis, agreement was moderate between TAUS and CT for calcifications/intraductal stones (k=0.51) and PD irregularities (k=0.60).
CONCLUSIONS: CP patients in this cohort experience a higher burden of TAUS. There is moderate to good agreement between TAUS and CT for CP findings including calcifications and PD irregularities. TAUS is a promising alternative to CT for serial monitoring of progression to CP if anesthesia and radiation need to be avoided. Head-to-head studies are needed.

David Troendle

UT Southwestern Medical Center

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