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Risk Factors for Post-Endoscopic Retrograde Cholangio-Pancreatography Pancreatitis in Children With Chronic
Arghya Samanta1, Srinivas Srinidhi Vadlapudi1, Anshu Srivastava1
1From the Departments of Pediatric Gastroenterology.
Insights
Post-ERCP pancreatitis (PEP) affects 14.5% of children with chronic pancreatitis. Difficult cannulation is a key risk factor. A 4-hour amylase/lipase level below 3x ULN can safely rule out PEP.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Pancreatology
Background:
- Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) occurs in 3-16% of pediatric therapeutic ERCP procedures.
- Risk factors for PEP and early prediction using 4-hour post-ERCP amylase and lipase levels in children with chronic pancreatitis (CP) were evaluated.
Purpose of the Study:
- To identify risk factors for PEP in children with CP.
- To assess the utility of 4-hour post-ERCP amylase and lipase levels for early PEP prediction.
Main Methods:
- Retrospective study of 30 children with CP undergoing 62 ERCP procedures.
- Serum amylase and lipase measured pre-ERCP, 4-hours, and 24-hours post-ERCP.
- Multivariate analysis to determine independent risk factors and cutoff values for enzyme levels.
Main Results:
- PEP occurred in 14.5% of procedures; difficult cannulation was the independent risk factor (OR 5.83).
- 4-hour amylase >3.3x ULN and lipase >5x ULN showed high diagnostic accuracy for PEP.
- 4-hour amylase/lipase <3x ULN effectively excluded PEP (100% sensitivity).
Conclusions:
- Difficult cannulation is a significant independent risk factor for PEP in pediatric CP patients.
- Asymptomatic patients with 4-hour amylase/lipase <3x ULN can be safely discharged, aiding early PEP prediction.
Background:
Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) is seen in 3% to 16% of children undergoing therapeutic endoscopic retrograde cholangio-pancreatography (ERCP). We evaluated the risk factors of PEP and utility of 4-hour post-ERCP amylase and lipase for early prediction of PEP in children with chronic pancreatitis (CP).
Materials And Methods:
Thirty children with CP (boys 20, 14.3 [interquartile range, 9.3-16] years) who underwent 62 ERCP procedures were studied. Clinical and procedural details with outcome were noted. Serum amylase and lipase were measured before, 4 hours, and 24 hours after ERCP. Multivariate analysis was done to identify risk factors for PEP. Cutoff scores of 4-hour amylase and lipase were identified.
Results:
PEP occurred in 14.5% (9/62) of ERCP procedures (mild, 8; moderate, 1) with no mortality. On univariate analysis, endoscopic sphincterotomy ( P = 0.04), difficult cannulation ( P = 0.004), and prior PEP ( P = 0.036) were risk factors, while prior ERCP ( P = 0.04) was protective. Difficult cannulation (odds ratio, 5.83; 95% confidence interval, 1.329-25.592) was the independent risk factor on multivariate analysis overall and for first ERCP session alone. Amylase >3.3 times upper limit of normal (ULN) and lipase of >5 times ULN at 4 hours had best sensitivity and specificity for diagnosis of PEP. All cases with PEP were symptomatic by 6 hours and none had amylase/lipase <3 ULN at 4 hours. Amylase/lipase of <3 ULN at 4 hours could exclude PEP with good sensitivity (100%) and specificity (76% and 81%, respectively).
Conclusions:
PEP occurred in 14.5% of procedures in children with CP, with difficult cannulation being the independent risk factor. Asymptomatic patients with 4-hour amylase/lipase <3 times ULN can be safely discharged.
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