Diagnostic Approach to Recurrent Pancreatitis in Children

Initial Evaluation

The American Gastroenterological Association recommends obtaining comprehensive personal and family history focusing on medication use that could trigger pancreatitis in children with recurrent pancreatitis 1
Laboratory testing should include liver biochemistries and serum triglycerides and calcium levels to identify biliary and metabolic causes, as suggested by the European Society of Gastrointestinal Endoscopy 2, 1
Abdominal ultrasound should be performed to evaluate for gallstones, and repeated if initially negative, as recommended by the North American Society for Pediatric Gastroenterology 2, 1

Endoscopic ultrasound (EUS) is the preferred diagnostic test for unexplained recurrent pancreatitis in children, according to the American Society for Gastrointestinal Endoscopy, and can detect microlithiasis, pancreatic tumors, and anatomical variations 3, 1
MRI with MRCP is a complementary or alternative diagnostic test to EUS, particularly helpful in identifying pancreatic ductal abnormalities and anatomical variants, as recommended by the Society of Abdominal Radiology 3, 1
Contrast-enhanced CT scan is indicated to exclude pancreatic tumors, especially in older children, as suggested by the European Society of Gastrointestinal and Abdominal Radiology 4, 1

ERCP should not be performed routinely for diagnostic purposes alone due to its associated risks, but is indicated in specific situations such as presence of jaundice or dilated common bile duct, as recommended by the American Society for Gastrointestinal Endoscopy 1, 2, 4
ERCP is also indicated when therapeutic intervention is anticipated, such as stone removal or stenting, as suggested by the European Society of Gastrointestinal Endoscopy 1

The etiology of pancreatitis should be determined in 75-80% of cases, and no more than 20-25% should remain classified as "idiopathic", as recommended by the American Gastroenterological Association 4, 1