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Risk Factors for Post-ERCP Pancreatitis in Pediatric and Young Adult Patients
Ahmad M Hassan1, Tom K Lin2,3, Milton T Smith1
1From the Department of Internal Medicine, University of Cincinnati, Cincinnati, OH.
Insights
Post-ERCP pancreatitis (PEP) is a common complication. In pediatric patients, pancreatic duct stenting and specific procedural factors were associated with PEP, though not in high-risk subgroups. Further trials are needed to clarify interventions.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Clinical Outcomes Research
Background:
- Post-ERCP pancreatitis (PEP) is the most frequent complication following endoscopic retrograde cholangiopancreatography (ERCP).
- Existing data on prophylactic pancreatic duct (PD) stenting in pediatric patients suggest a potential increased risk of PEP, but evidence is limited.
- Identifying factors associated with PEP in pediatric populations is crucial for risk stratification and prevention strategies.
Purpose of the Study:
- To identify patient and procedure-related factors associated with the development of post-ERCP pancreatitis (PEP) in a pediatric cohort.
- To analyze the impact of interventions such as rectal indomethacin and pancreatic duct stenting on PEP rates in children.
- To investigate the association between genetic factors, specifically PRSS1 mutations, and PEP in pediatric patients.
Main Methods:
- Retrospective review of pediatric patients undergoing ERCP between 2012 and 2020 at a single institution.
- Collection and analysis of patient demographics, procedural details, and outcomes, including PEP.
- Statistical analysis using Chi-square or Fisher exact tests and Mann-Whitney-Wilcoxon tests to identify significant associations.
Main Results:
- Seven hundred thirty-six ERCPs were performed, with a PEP rate of 12.8% (94 cases), predominantly mild.
- Factors associated with PEP included pancreatic indication, native major papilla, pancreatic duct cannulation/injection, and higher ASGE complexity scores.
- While rectal indomethacin and PD stenting showed association with PEP in initial analysis, this was not persistent in high-risk subgroups. A lower proportion of PEP patients had PRSS1 mutations.
Conclusions:
- A significant rate of PEP was observed in this pediatric cohort, potentially linked to higher pancreatic indications and procedural complexity.
- The association of PD stenting with PEP requires further investigation, particularly in high-risk pediatric patients.
- Prospective randomized trials are necessary to definitively establish the utility of prophylactic interventions and understand PEP development in pediatric ERCP.
Objectives:
Post-ERCP pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Limited existing data suggest that prophylactic pancreatic duct (PD) stenting in pediatric patients may increase the risk of PEP. The aim of this study is to identify factors associated with PEP in pediatric patients.
Methods:
Patients at a single institution who underwent ERCP between 2012 and 2020 were retrospectively reviewed. Patient and procedure-related factors were collected. Data were analyzed using Chi-square or Fisher exact tests as appropriate and Mann-Whitney-Wilcoxon tests.
Results:
Seven hundred thirty-six ERCPs were performed for 402 unique patients. Ninety-four cases were complicated by PEP (12.8%), of which 91 were mild and 3 were moderately severe. Pancreatic indication, native major papilla, PD cannulation and injection, and higher American Society for Gastrointestinal Endoscopy (ASGE) complexity were associated with PEP. A higher proportion of patients who received rectal indomethacin (65% vs 47%, P = 0.002), or who had placement of a prophylactic (31% vs 20%, P = 0.01) or therapeutic PD stent (37% vs 27%, P = 0.04) developed PEP; however, in a subgroup analysis of high-risk patients, this association was not persistent. A smaller proportion of PEP patients had PRSS1 mutation compared to non-PEP patients (22% vs 40%, P = 0.04).
Conclusions:
This study evaluates factors associated with developing PEP in a large pediatric cohort. A high rate of PEP was observed, likely secondary to higher rates of pancreatic indication and higher ASGE complexity scores compared to previously reported literature. Randomized prospective trials are needed to better define the utility of various interventions.
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