S40 The Clinical Course of Chronic Pancreatitis in Children With Anatomic Anomalies of Pancreatic Duct

Introduction: The etiology of chronic pancreatitis (CP) in children is varied and includes anatomic anomalies (AA), gene mutations and others. Anatomical defects of pancreas are very rare to find, but the most common of them is pancreas divisum. The aim of this study was to evaluate the role of anatomic anomalies of pancreatic duct in pediatric chronic pancreatitis. Methods: Five hundred seventy-three children with CP, hospitalized since 1990 to 2024, were enrolled into the study. The medical records of these patients were reviewed for data on the presentation, diagnostic findings, endoscopic and surgical treatment. All children had preceding imaging studies, including ultrasound, computed tomography, magnetic resonance cholangiopancreatography and/or endoscopic retrograde cholangiopancreatography (ERCP). All children were screened for gene mutations. Results: Anatomic anomalies were found in 102 children (17.8%). Pancreas divisum was observed in 63 (62%); ansa pancreatica in 19; ABPU in 9; annular pancreas in 2 children. In 9 children we observed very rare AA. 67 patients (66%) with anatomical defects had gene mutations (PRSS1- 9 patient; SPINK1- 34 patients; CTRC- 24 patients; CFTR- 18 patients; LPL, TRPV6, CUZD1 and UBR1 in 1 pt). There was no difference in age of the disease onset between AA group and non-AA group (8.4 vs 8.7 years; NS). In children with AA ERCP had mean 2.1o Cambridge grade, vs 1.6o, P < 0.05. 43% patients with AA had calcifications in the imagine studies vs 33%, P < 0.05. Therapeutic ERCP was performed in 81 pts (79%; average 4× vs 47%; P < 0.05). Surgical intervention was done in 26 children (25% vs 14%). Pancreatic duct stenting was done in 40 children (39% vs 20%; P < 0.05). Conclusion: Anatomic anomalies of pancreatic duct are common etiologic factors of CP in children. CP in patients with AA has worse clinical course than CP in children without AA. CP is a multifactorial disease. In children with AA coexisting etiological factors, like gene mutations, should be investigated. Children with CP and AA are often treated by endoscopic and surgical procedures.