Utility and utilization of transabdominal ultrasound in pediatric patients with acute recurrent or chronic pancreatitis

Objectives: Transabdominal ultrasound (TAUS) is frequently utilized in pediatric acute pancreatitis, but less is known about its use in acute recurrent (ARP) or chronic pancreatitis (CP). 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: Demographic and imaging data from physician questionnaires were obtained for patients with available TAUS data. Utilization and findings were compared between ARP and CP groups. Kappa statistics were used to compare agreement of TAUS to computed tomography (CT), magnetic resonance imaging/cholangiopancreatography (MRI/MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) for CP findings. Results: There were 895 patients (460 ARP, 435 CP) included with 2531 TAUS examinations. Mean number of TAUS per year was similar between CP and ARP patients (0.90 vs. 0.90, p = 0.97). The pancreas was well visualized in 65% of examinations (60% ARP vs. 68% CP, p ≤ 0.001). TAUS and CT demonstrated the most consistent agreement among other modalities with kappa values ranging from 0 to 0.66 with substantial agreement for pancreatic duct irregularities (ĸ = 0.62) and moderate agreement for calcifications (ĸ = 0.57). Agreement between other modalities and TAUS was generally lower and diminished closer to CP diagnosis date. Conclusion: This is the largest report of TAUS findings in children with ARP or CP. TAUS has several benefits in the initial or emergent evaluation of ARP including availability and tolerance. The ability of TAUS to screen for progression of disease requires further study.