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Clinical and stool microbiome correlates of simple post-ERCP hyperamylasemia in children undergoing therapeutic ERCP
Xueqi Wang1, Yifan Zhang1, Mao Ye1
1Department of General Surgery, Capital Center for Children's Health, Capital Medical University, Capital Institute of Pediatrics, Beijing, China.
Insights
Simple hyperamylasemia after ERCP in children is linked to complex procedures and specific gut bacteria. Lower gut diversity and higher Enterococcus levels were observed in children with post-ERCP hyperamylasemia, suggesting potential risk factors.
Area of Science:
- Gastroenterology
- Microbiome Research
- Pediatric Endoscopy
Background:
- Simple post-ERCP hyperamylasemia is common in children but lacks data linking procedural factors and gut microbiome.
- Pediatric data on post-ERCP hyperamylasemia and its association with stool microbiome features are limited.
Purpose of the Study:
- To explore associations between procedural characteristics, stool microbiome features, and simple post-ERCP hyperamylasemia in children.
- To identify potential risk factors for post-ERCP hyperamylasemia in pediatric patients undergoing therapeutic ERCP.
Main Methods:
- An observational pilot study of 24 pediatric ERCP procedures.
- Collected pre-ERCP stool metagenomic data to analyze microbiome features (Shannon diversity, Enterococcus, Bifidobacterium abundance).
- Compared clinical and intraprocedural variables between children with and without post-ERCP hyperamylasemia.
Main Results:
- Hyperamylasemia occurred in 33.3% of procedures.
- Children with hyperamylasemia had longer procedure times, more difficult cannulation, and increased pancreatic duct cannulation.
- Associated microbiome features included lower Shannon diversity and higher Enterococcus abundance.
Conclusions:
- Simple post-ERCP hyperamylasemia in children is associated with technically demanding procedures and a low-diversity, Enterococcus-enriched gut microbiome.
- Findings are hypothesis-generating and require prospective multicenter validation.
- Further research may inform pediatric ERCP surveillance and risk stratification.
Background:
Simple post-ERCP hyperamylasemia is a common biochemical finding after therapeutic endoscopic retrograde cholangiopancreatography (ERCP), but pediatric data integrating procedural characteristics with stool microbiome features remain limited.
Methods:
We performed an exploratory single-center observational pilot study of 24 successful therapeutic ERCP procedures in children younger than 18 years with pancreatobiliary obstructive disorders between January 2024 and December 2025. The primary endpoint was simple post-ERCP hyperamylasemia, defined as serum amylase >3 times the upper limit of normal within 24 h after ERCP without new or worsening abdominal pain. Baseline clinical variables, predefined stool microbiome features derived from pre-ERCP metagenomic data (Shannon diversity, Enterococcus abundance, and Bifidobacterium abundance), and intraprocedural variables were compared between groups. Exploratory signal prioritization was used only to identify candidate associations for future validation.
Results:
Hyperamylasemia occurred in 8/24 procedures (33.3%). Compared with non- hyperamylasemia group, the affected children had higher baseline gamma-glutamyl transferase and C-reactive protein, longer procedure time, more difficult cannulation, more inadvertent pancreatic duct cannulation, more pancreatic contrast injection, and more rescue precut access. Stool microbiome features in the hyperamylasemia group included lower Shannon diversity, higher Enterococcus abundance, and lower Bifidobacterium abundance. Procedure time and Shannon diversity emerged as the most interpretable combined signals, but all model estimates should be viewed cautiously because of the small event count.
Conclusion:
In this pilot dataset, simple post-ERCP hyperamylasemia clustered with technically demanding procedures and a low-diversity, Enterococcus-enriched stool microbiome profile. These findings are hypothesis-generating and require prospective multicenter validation before they can inform pediatric ERCP surveillance or risk-stratification research.
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