Spectrum and determinants of acute and chronic pancreatitis in choledochal cyst

Pancreatitis is associated with choledochal cyst (CDC). We aimed to investigate the occurrence of acute and chronic pancreatitis in a cohort of pediatric and adult patients with CDC and the predictive factors for pancreatitis.

We conducted a retrospective cohort study of 654 consecutive patients who underwent choledochal cyst excision between July 2004 and July 2024 at a tertiary care center. Patients were classified as having acute pancreatitis (AP), chronic pancreatitis (CP), or no pancreatitis (NP) based on preoperative clinical, biochemical, and imaging criteria. Outcomes were compared between pediatric (<18 years) and adult (≥18 years) patients. Multivariable logistic regression was used to identify factors independently associated with AP and CP.

Pancreatitis was present in 151 patients (23.1%): 93 (14.2%) had AP and 58 (8.9%) had CP. AP was significantly more frequent in pediatric patients (18.99% vs. 11.11%, p = 0.006). Adults had significantly longer duration of symptoms and biliary interventions. On multivariate analysis, pediatric age (<18 years) was independently associated with a higher likelihood of AP (odds ratio [OR] 2.05, p = 0.002). Pancreas divisum was independently associated with CP (OR 3.69, p = 0.002). Pancreatitis recurrence after CDC excision was 6.9% and 7.7% in the AP and CP groups which might be an under-estimation because of low follow-up (55.6%; median 96.5 months), CONCLUSIONS: Acute pancreatitis predominates in pediatric patients. Apart from a higher prevalence of pancreas divisum, no predictive factors were found for CP. This should be interpreted cautiously because of retrospective non standardized imaging assessment.