Risk Factors for Post-ERCP Pancreatitis in Pediatric and Young Adult Patients.

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.