BACKGROUND:The prevalence of Helicobacter pylori (H. pylori) infection in children is high. Current diagnostic methods, particularly invasive techniques like gastroscopy, pose challenges for pediatric populations, highlighting the need for reliable non-invasive alternatives. AIMS:This study aimed to evaluate the diagnostic value of salivary and urinary exosomes for detecting H. pylori infection and clarithromycin resistance in children. METHODS:Saliva and urine samples were collected from children prior to elective gastroscopy. Exosomal DNA was extracted and subjected to qPCR for the detection of H. pylori DNA and clarithromycin resistance. The sensitivity and specificity of the salivary and urinary exosome tests were calculated against the reference standard, and their performance in detecting resistance was compared with tissue-based results. RESULTS:Among 500 enrolled children, the H. pylori infection rate was 31.6%. Analysis of 500 salivary and 80 urine samples showed that salivary exosomes detected H. pylori with a sensitivity of 93.67% and specificity of 80.11%. Urinary exosomes offered higher specificity (90.56%) but lower sensitivity (62.96%). In the subset of 113 infected children tested for resistance, salivary exosome testing identified clarithromycin resistance in 17.70% of cases, showing a 91.15% concordance with gastric tissue testing (15.93%). The agreement between the two methods was substantial. CONCLUSION:Salivary exosome-based detection represents a highly sensitive and well-tolerated non-invasive method for diagnosing H. pylori infection in children. It also demonstrates substantial agreement with invasive methods in identifying clarithromycin resistance, offering a promising tool to guide precise eradication therapy in the pediatric population.

Chronic and acute pancreatitis (CP and AP, respectively) are debilitating conditions with significant morbidity and mortality, necessitating a comprehensive understanding of their underlying mechanisms. This study provides a high-resolution, multi-omics investigation into the genetic and immune cell underpinnings of pancreatitis, integrating rare familial CP with a large cohort of patients with AP. Utilizing an integrative approach that combined whole-exome sequencing (WES) from two pediatric CP patients and their family members with single-cell RNA sequencing (scRNA-seq) and bulk transcriptomics from a public AP cohort (n = 119), we identified a shared molecular and cellular pathology. WES of the CP family revealed heterozygous mutations in 12 novel genes, including EXOC4, ATG2A, and UNC80. Functional enrichment analysis highlighted autophagy, cell adhesion, and vesicle-mediated transport as the key biological processes implicated in the pathophysiology of both conditions. Single-cell profiling of peripheral blood mononuclear cells (PBMCs) from the CP family revealed a marked increase in the proportion of naive B cells and an altered activity of CD8+ T cells, suggesting a dysregulated B-cell-mediated immune response. This observation was corroborated in the AP cohort, where CIBERSORT analysis revealed a significant increase in both naive B cells and CD8+ T cells correlating with the disease severity. Weighted gene co-expression network analysis (WGCNA) on the AP cohort uncovered 14 gene modules associated with disease progression. These modules were significantly enriched for pathways central to the innate immune response, including complement-dependent cytotoxicity and neutrophil degranulation, providing a molecular link to the observed immune cell infiltration. An artificial intelligence (AI)-driven model incorporating 110 CP family-related genes (GTCPFs) demonstrated exceptional predictive capability (average AUC > 0.84) for AP severity, highlighting the translational potential of our findings. The model identified a robust signature of 17 genes, including ATG2A, EXOC4, and TNS1, which may serve as novel diagnostic and prognostic biomarkers. Our findings provide a unified view of the pathogenesis of pancreatitis, linking novel genetic variants to specific immune cell and transcriptomic signatures. This integrative approach underscores the critical importance of both genetic and immune factors in CP and AP, identifying potential biomarkers and therapeutic targets and paving the way for personalized medicine in the management of these challenging conditions.

BACKGROUND:Pediatric chronic pancreatitis (CP) is associated with significant morbidity and nutritional challenges, yet the impact of endoscopic retrograde cholangiopancreatography (ERCP) on clinical and nutritional outcomes in children remains incompletely defined. This study aimed to evaluate age associated outcomes following ERCP in children. METHODS:We conducted a retrospective cohort study of 154 pediatric patients who underwent 360 ERCP procedures between 2019 and 2024 with age-stratified analyses. The primary outcomes included the rate of pre-discharge pain relief, defined as a discharge Visual Analogue Scale (VAS) score <4, the incidence of post-ERCP pancreatitis (PEP), and changes in body mass index (BMI). Nutritional status was assessed using BMI, weight-for-age Z-scores, and vitamin D levels. Follow-up data were available for 134 patients (87%) at ≥2 years. Secondary outcomes included recurrent pancreatitis within 2 years after ERCP, nutritional evolution, and pancreatic function. RESULTS:High rates of nutritional abnormalities were observed, including vitamin D deficiency (61.2%), undernutrition (18%), and overweight/obesity (5.2% & 5.2%). ERCP technical success was 99.17%. In this chronic pancreatitis-only cohort, PEP occurred after 111 of 360 procedures (30.8%) and was more frequent in preschool-aged than school-aged children (35.13% vs. 27.8%, P = 0.023). School-aged children showed a higher pre-discharge pain relief rate and significant VAS score reduction, whereas preschool-aged children had higher PEP rates and less statistically evident VAS score improvement. BMI showed an increasing trend mainly in school-aged children, with no significant change in preschool-aged children. CONCLUSIONS:ERCP appears feasible in pediatric CP, with high technical success and predominantly mild complications. Age was associated with differences in pain relief and PEP risk. Nutritional findings should be interpreted cautiously as a limited longitudinal signal rather than definitive improvement. IMPACT:Patient age was associated with differences in ERCP-related outcomes in pediatric chronic pancreatitis. School-aged children showed a higher pre-discharge pain relief rate, whereas preschool-aged children showed higher PEP rates and less statistically evident VAS score improvement, suggesting the need for careful age-specific risk assessment. To our knowledge, this is one of the largest age-stratified studies evaluating ERCP-related clinical and nutritional outcomes in pediatric chronic pancreatitis. These findings may support age-specific risk assessment, closer monitoring of younger children, and more individualized nutritional follow-up after ERCP.

Background:While endoscopic ultrasound (EUS) is well established as a standard diagnostic and therapeutic tool in adults, its use in children remains limited. This study assessed the indications, safety, and clinical impact of diagnostic and therapeutic EUS in children with pancreatobiliary and gastrointestinal disorders. Methods:We retrospectively analyzed pediatric patients with pancreatobiliary and gastrointestinal disorders who underwent EUS at our institution between January 2022 and June 2025. Results:Fifty-three EUS procedures were conducted in children with a median age of 9.6 ± 3.0 years. Indications for EUS included acute recurrent pancreatitis (n = 15), suspected chronic pancreatitis (n = 12), suspected choledocholithiasis (n = 7), obstructive jaundice (n = 5), pancreatic mass (n = 1), gastric mucosal lesions (n = 6), suspected esophageal lymphoma recurrence (n = 1), suspected autoimmune hepatitis (n = 1) and pancreatic pseudocyst (PPC, n = 5). ERCP was performed during the same anesthesia for all children requiring it post-EUS. Five patients underwent cystogastrostomy for symptomatic PPC with 100% technical and clinical success. The efficacy of EUS in guiding definitive therapeutic decisions and invasive interventions was 100%. Notably, no major complications occurred. Conclusion:EUS is safe and effective diagnostic and therapeutic modality in pediatric patients with pancreatobiliary and gastrointestinal disorders.

Gastrointestinal graft-versus-host disease (GI-GVHD) is diagnosed via histological examination of endoscopic mucosal biopsy specimens; however, the optimal endoscopic diagnostic strategy remains unclear. This study aimed to identify key clinical symptoms, gastrointestinal sites, and endoscopic approaches for diagnosing pediatric GI-GVHD. A retrospective analysis of post-bone marrow stem cell transplant patients with gastrointestinal symptoms at Shanghai Children’s Medical Center (2018–2023) was conducted. A nomogram prediction model was developed using univariate and multivariate logistic regression analyses based on clinical, endoscopic, and histopathological characteristics. Among 63 patients (29 GI-GVHD, 34 non-GI-GVHD), GI-GVHD was associated with skin rejection (P = 0.002), diarrhea (P = 0.07), and bloody stools (P = 0.009). C-reactive protein (CRP) > 30 mg/L and mucosal ulcers were more common in the non-GI-GVHD group than the GI-GVHD group (P = 0.016, P = 0.029). Independent GI-GVHD indicators included skin rejection (P = 0.035), apoptotic corpuscles (P = 0.030), mucosal edema (P = 0.007), and tortoise shell-like mucosa (P = 0.020). Transverse colonic mucosal edema (76.2

The main treatments for biliary dilatation (BD) are surgical resection and choledochojejunostomy. However, various factors lead to the postponement of early surgical intervention in pediatric BD patients. This study aimed to analyze the effectiveness and limitations of endoscopic retrograde cholangiopancreatography (ERCP) in BD pediatric patients. Data on patients with BD treated at two centers from June 2018 to June 2022 were retrospectively collected. Patients were categorized into five groups according to Todani classification. Clinical features, ERCP processes, ERCP-related complications, ERCP effectiveness and its limitations were reviewed. A cohort of 77 symptomatic BD patients was evaluated, with pancreaticobiliary malformation (PBM) identified in 68.8

Background: Congenital diarrhea is persistent diarrhea that manifests during the neonatal period. Mutations in DGAT1, which is crucial for triglyceride synthesis and lipid absorption in the small intestine, are causal factors for congenital diarrhea. In this study, we aimed to determine the value of tissue RNA sequencing (RNA-seq) for assisting with the clinical diagnosis of some genetic variants of uncertain significance. Methods: We clinically evaluated a patient with watery diarrhea, vomiting, severe malnutrition, and total parenteral nutrition dependence. Possible pathogenic variants were detected using whole-exome sequencing (WES). RNA-seq was utilized to explore the transcriptional alterations in DGAT1 variants identified by WES with unknown clinical significance, according to the American College of Medical Genetics guidelines. Systemic examinations, including endoscopic and histopathological examinations of the intestinal mucosa, were conducted to rule out other potential diagnoses. Results: We successfully diagnosed a patient with congenital diarrhea and protein-losing enteropathy caused by a DGAT1 mutation and reviewed the literature of 19 cases of children with DGAT defects. The missense mutation c.620A>G, p.Lys207Arg located in exon 15, and the intronic mutation c.1249-6T>G in DGAT1 were identified by WES. RNA-seq revealed two aberrant splicing events in the DGAT1 gene of the patient’s small intestinal tissue. Both variants lead to loss-of-function consequences and are classified as pathogenic variants of congenital diarrhea. Conclusions: Rare DGAT1 variants were identified as pathogenic evidence of congenital diarrhea, and the detection of tissue-specific mRNA splicing and transcriptional effects can provide auxiliary evidence.

We aimed to investigate whether early clinical indicators were associated with eventual disease severity, and to develop a predictive model for severe asparaginase-associated pancreatitis (AAP). Seventy-five acute lymphoblastic leukaemia (ALL) cases with AAP admitted to Shanghai Children’s Medical Center from March 2013 to August 2023 were divided into non-severe (n = 44) and severe (n = 31) groups based on Atlanta diagnostic and AAP grading criteria. We compared essential information, asparaginase(ASP) dosage form, cumulative dose, clinical characteristics and laboratory tests between the groups. Statistically significant indicators were analysed with multifactorial logistic regression to identify independent risk factors for severe AAP. Receiver operating characteristic (ROC) curves assessed the early predictive value of age, C-reactive protein (CRP) and fibrinogen (FIB) levels. In the early stages of AAP onset, significant differences in age, CRP, platelet count, red blood cell distribution width, albumin, calcium, FIB, and D-dimer levels were found between the non-severe and severe AAP groups (p < 0.05). Multifactorial logistic regression identified age (odds ratio [OR] = 1.204, p = 0.035), CRP (OR = 1.334, p = 0.003), and FIB (OR = 0.85, p = 0.008) as independent predictors of severe AAP. ROC analysis showed an area under the curves (AUC) for age was 0.681 (95

Chronic hypoxia, common in neonates, disrupts gut microbiota balance, which is crucial for brain development. This study utilized cyanotic congenital heart disease (CCHD) patients and a neonatal hypoxic rat model to explore the association. Both hypoxic rats and CCHD infants exhibited brain immaturity, white matter injury (WMI), brain inflammation, and motor/learning deficits. Through 16s rRNA sequencing and metabolomic analysis, a reduction in B. thetaiotaomicron and P. distasonis was identified, leading to cholic acid accumulation. This accumulation triggered M1 microglial activation and inflammation -induced WMI. Administration of these bacteria rescued cholic acid -induced WMI in hypoxic rats. These findings suggest that gut microbiota-derived cholic acid mediates neonatal WMI and brain inflammation, contributing to brain immaturity under chronic hypoxia. Therapeutic targeting of these bacteria provides a non-invasive intervention for chronic hypoxia patients.

BackgroundAsparaginase-associated pancreatitis (AAP) is a major challenge for continuing asparaginase therapy. We aimed to investigate the acute and long-term complications and survival rates related to first and second AAP episodes in Chinese children with haematological malignancies.MethodsWe retrospectively analysed clinical data of children with pancreatitis who received asparaginase chemotherapy for acute lymphoblastic leukaemia (ALL), acute mixed cell leukaemia, and non-Hodgkin’s lymphoma at Shanghai Children’s Medical Center from November 2013 to November 2023.ResultsOf the 76 children included in the study, 12 had local complications (15.79%), with no deaths recorded. Systemic complications manifested in 28 patients (36.84%), resulting in 3 deaths (3.95%). Four patients (5.26%) developed long-term complications (chronic pancreatitis or insulin-dependent diabetes mellitus). No significant differences in local or long-term complications were recorded between children in the asparaginase re-exposed (n=39) and non-re-exposed (n=45) groups. Among the re-exposed patients, eight (25.81%) experienced a second attack without fatalities or complications. Survival analysis of intermediate- to high-risk patients revealed a significantly higher event-free survival (EFS) rate for the re-exposed group than for the non-re-exposed group. The second AAP episode’s occurrence and severity had no relation to the first AAP episode’s severity, and the second AAP episode was significantly less severe than the first (p<0.001).ConclusionsThe second AAP episode’s occurrence is unrelated to the first AAP episode’s severity, and the second AAP episode’s severity is significantly lower than that of the first. Further, asparaginase therapy could improve EFS in children with intermediate and high-risk ALL.

Allogenic hematopoietic stem cell transplantation is the most effective and fundamental method to cure malignant blood diseases at present.Gastrointestinal graft-versus-host disease is a common complication after transplantation.It requires early diagnosis and treatment, because of its high incidence rate, severe clinical manifestations, complex gastrointestinal manifestations and poor prognosis.In clinical practice, it is often differentiated from causes such as infection and chemotherapy drugs.Endoscopic manifestations and pathological findings obtained through endoscopy are important evidence for the diagnosis of gastrointestinal graft-versus-host disease, especially for gastrointestinal graft-versus-host disease that is difficult to be diagnosed clinically.This article reviews the significance, manifestations, biopsy sites, and pathological features of endoscopy in the diagnosis of gastrointestinal graft-versus-host disease.

非侵入性地评估肠道状态和功能，辅助诊断，指导治疗是发展自动化听诊肠鸣音（BS）的主要目的。得益于工程学的发展，自动化听诊BS的技术研究取得长足进步。自动化听诊主要分为BS信号采集与信号处理两个阶段。随着人工智能（AI）在信号处理方面的应用，自动化听诊BS的工程学技术进步迅速。自动化听诊BS的临床研究集中于肠梗阻识别、术后胃肠功能监测及肠易激综合征（IBS）诊断等方面，目前尚未成熟应用于临床，加速此过程的转化需要工程学与临床的良性互动和密切合作。

Stroke is the second leading disease globally, with high morbidity and mortality among the middle-aged and elderly populations. Stroke prognosis is positively correlated with resistance of vasculature network and angiogenesis. Patients with higher vascular density in the peri-infarct region have higher survival and recovery rates. Previous studies have demonstrated that angiogenesis can restore the blood and oxygen supply of the penumbra. Active angiogenesis relies on endothelial cell (EC) proliferation. But currently, there is a lack of imaging tools to investigate angiogenesis after a stroke at the centimeter scale and sub-micron resolution. In this study, we combine the Xray microscope and scanning electron microscope to achieve this target. By vascular corrosion casting (VCC) of a mouse’s brain, the proposed method reveals the changes of microvasculature below 8 $\mu \mathrm{m}$ diameter and ECs imprinting in penumbra after ischemic stroke (IS). Our method is successfully applied for both aged and young mouse brain samples. We also developed a post-processing procedure to analyze the characteristics of microvasculature and ECs. There are obvious differences between young and aged mouse’s brains. This work established a standardized cross-scale imaging method for ischemic stroke studies.

BACKGROUND: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.AIM:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in treating recurrent pancreatitis due to AAP.METHODS: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.RESULTS: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 the continuous administration of ASP, but eating was not affected. The postoperative weight gain was 1.5-8 kg. There was one case of post ERCP pancreatitis and two cases of postoperative infections; all recovered after medication.CONCLUSION:ERCP improved clinical symptoms and reduced the incidence of pancreatitis, and was shown to be a safe and effective method for improving the management of recurrent pancreatitis due to AAP.

BACKGROUND:Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Currently, there is no suitable treatment for post-ERCP pancreatitis (PEP) prophylaxis. Few studies have prospectively evaluated interventions to prevent PEP in children.AIM:To assess the efficacy and safety of the external use of mirabilite to prevent PEP in children.METHODS:This multicenter, randomized controlled clinical trial enrolled patients with chronic pancreatitis scheduled for ERCP according to eligibility criteria. Patients were randomly divided into the external use of mirabilite group (external use of mirabilite in a bag on the projected abdominal area within 30 min before ERCP) and blank group. The primary outcome was the incidence of PEP. The secondary outcomes included the severity of PEP, abdominal pain scores, levels of serum inflammatory markers [tumor necrosis factor-alpha (TNF-α) and serum interleukin-10 (IL-10)], and intestinal barrier function markers [diamine oxidase (DAO), D-lactic acid, and endotoxin]. Additionally, the side effects of topical mirabilite were investigated.RESULTS:A total of 234 patients were enrolled, including 117 in the external use of mirabilite group and the other 117 in the blank group. The pre-procedure and procedure-related factors were not significantly different between the two groups. The incidence of PEP in the external use of mirabilite group was significantly lower than that in the blank group (7.7% vs 26.5%, P < 0.001). The severity of PEP decreased in the mirabilite group (P = 0.023). At 24 h after the procedure, the visual analog scale score in the external use of mirabilite group was lower than that in the blank group (P = 0.001). Compared with those in the blank group, the TNF-α expressions were significantly lower and the IL-10 expressions were significantly higher at 24 h after the procedure in the external use of mirabilite group (P = 0.032 and P = 0.011, respectively). There were no significant differences in serum DAO, D-lactic acid, and endotoxin levels before and after ERCP between the two groups. No adverse effects of mirabilite were observed.CONCLUSION:External use of mirabilite reduced the PEP occurrence. It significantly alleviated post-procedural pain and reduced inflammatory response. Our results favor the external use of mirabilite to prevent PEP in children.

We aimed to describe the clinical characteristics of pediatric patients with pancreatitis caused by pancreaticobiliary malformation and to evaluate the efficacy and safety of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of the disease. Medical records of pediatric patients with pancreatitis related to pancreaticobiliary malformation diagnosed by ERCP and treated in our hospital between April 2008 and December 2020 were retrospectively reviewed. Clinical manifestations, laboratory indicators, genetic testing results and imaging findings including MRCP were collected. Of the 148 patients with pancreaticobiliary malformation-related pancreatitis, 90 (60.8%) had pancreaticobiliary maljunction (PBM), 52 (35.1%) had pancreatic divisum (PD), and six (4.1%) had annular pancreas (AnnP). Compared with the PD group, patients with PBM were younger ( P  < 0.001), and were more likely to have jaundice ( P  < 0.001) and fever ( P = 0.034). Genetic mutation was found in 51.6% of patients with PD, 50.0% with AnnP, and 15.0% with PBM. Diagnostic rate of PBM, PD, and AnnP using MRCP was 46.7%, 15.4%, and 100%, respectively. In total, 87.8% of patients had symptomatic improvement after endoscopic treatment. ERCP-related complications were observed in 28 out of the 260 procedures, including post-ERCP pancreatitis (7.7%), infection (2.3%), and gastrointestinal bleeding (0.8%). PBM should be considered when jaundice and fever occur in pediatric patients. Genetic testing is recommended for those with PD and AnnP. The role of MRCP is limited in identifying pancreaticobiliary malformation in children. ERCP is effective and safe for the diagnosis and treatment for pediatric pancreatitis caused by pancreaticobiliary malformation.

目的:分析不同影像学方法在儿童胰胆管合流异常(PBM)的诊断价值,以提高对本病的认识.方法:回顾性分析我院30例经磁共振胰胆管成像(MRCP)及内镜下逆行胰胆管造影术(ERCP)诊断的儿童PBM,分析其临床资料及影像学检查结果并进行分型,探讨各影像学方法在诊断本病中的优势.结果:(1)临床资料:本组30例患儿,男性7例,女性23例,平均年龄4.3岁.(2)首发症状:腹痛24例,皮肤黄染6例,呕吐6例,体检发现1例.(3)实验室检查:血清淀粉酶或脂肪酶升高、肝功能异常共28例,实验室检查无异常2例.(4)影像学结果:本组30例患儿,MRCP明确诊断为PBM者22例(73.3％,22/30),其中分型为A型11例,B型2例,C型9例,D型0例;ERCP确诊者30例(100％,30/30),其中分型为A型13例,B型2例,C型14例,D型1例;29例均伴随不同程度的肝(内)外胆管扩张;MRCP提示胆总管中或下段结石12例,ERCP确诊结石共16例并诊断胆总管下段或胰管内蛋白栓17例.(5)随访:30例中19例接受1次ERCP检查,另有10例和1例因反复胰腺炎发作接受2次及3次ERCP检查.结论:对于临床上表现为腹痛反复发作,特别是同时合并黄疸、腹部包块、胰腺炎与肝功能不全等的患儿,需要考虑到PBM的可能性.MRCP对于本病早期诊断有一定提示作用,但仍有一定局限性;ERCP仍为目前诊断本病的金标准,在诊断、分型、治疗上具有不可取代的作用.

Objectives: We aimed to describe the clinical characteristics of pediatric patients with pancreatitis caused by pancreaticobiliary malformation and to evaluate the efficacy and safety of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of the disease.Methods: Medical records of pediatric patients with pancreatitis related to pancreaticobiliary malformation diagnosed by ERCP and treated in our hospital between April 2008 and December 2020 were retrospectively reviewed. Clinical manifestations, laboratory indicators, genetic testing results and imaging findings including MRCP were collected.Results: Of the 148 patients with pancreaticobiliary malformation-related pancreatitis, 90 (60.8%) had pancreaticobiliary maljunction (PBM), 52 (35.1%) had pancreatic divisum (PD), and six (4.1%) had annular pancreas (AnnP). Compared with the PD group, patients with PBM were younger (P < 0.001), and were more likely to have jaundice (P < 0.001) and fever (P = 0.034). Genetic mutation was found in 51.6% of patients with PD, 50.0% with AnnP, and 15.0% with PBM. Diagnostic rate of PBM, PD, and AnnP using MRCP was 46.7%, 15.4%, and 100%, respectively. In total, 87.8% of patients had symptomatic improvement after endoscopic treatment. ERCP-related complications were observed in 28 out of the 260 procedures, including post-ERCP pancreatitis (7.7%), infection (2.3%), and gastrointestinal bleeding (0.8%).Conclusions: PBM should be considered when jaundice and fever occur in pediatric patients. Genetic testing is recommended for those with PD and AnnP. The role of MRCP is limited in identifying pancreaticobiliary malformation in children. ERCP is effective and safe for the diagnosis and treatment for pediatric pancreatitis caused by pancreaticobiliary malformation.

内镜下逆行胰胆管造影术( ERCP)是诊断和治疗胆胰疾病的主要技术,因其创伤小、操作时间短、疗效好、恢复时间短等优势被广泛运用于临床,但ERCP是有创操作,并发症是不可避免的.内镜下逆行胰胆管造影术后胰腺炎( post-ERCP pancreati-tis,PEP)为ERCP术后最常见的并发症,如何预防PEP是临床一直关注的问题.据国内外研究统计,成人PEP的发生率为1. 6％ ～15. 7％,儿童为3. 0％ ～9. 7％,占术后总并发症的一半以上[1-2].西医疗法如非甾体类药物肛塞及内镜下放置支架对于预防PEP有一定的效果,但仍缺乏确切的临床研究支持[3].近几年临床研究发现,中医方剂"大柴胡汤""清胰汤"等对PEP有预防作用,中药预防PEP已成为当前临床研究的热点.本文就PEP的现状、发病机制、中医治疗的机制及优势进行综述.