Original article
Clinical endoscopy
Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population

https://doi.org/10.1016/j.gie.2014.11.022Get rights and content

Background

Risk factors for the development of post-ERCP pancreatitis (PEP) have not been identified in the pediatric population. It remains unclear what constitutes appropriate prophylaxis in this patient population.

Objectives

To assess the prevalence and severity of PEP in the pediatric population and identify factors associated with developing PEP and to evaluate the effect of prophylactic pancreatic duct stenting in high-risk patients.

Design

Retrospective analysis of an ERCP database at a single large pediatric center.

Setting

Academic center.

Patients

A total of 432 ERCPs performed on 313 patients younger than 19 years of age from January 2004 to October 2013.

Intervention

ERCP for any indication.

Main Outcome Measurements

Rates and severity of PEP, preprocedural and procedural risk factors for the development of PEP, and the effect of pancreatic stents on preventing PEP in high-risk patients.

Results

PEP occurred after 47 procedures (prevalence, 10.9%). Thirty-four cases were mild, 9 were moderate, and 4 were severe. There was no mortality. On multiple logistic analysis, pancreatic duct injection (P < .0001; odds ratio 30.8; 95% confidence interval [CI], 9.1-103.9) and pancreatic sphincterotomy (P < .01; OR 3.8; 95% CI, 1.6-9.8) were positively associated with PEP. A history of chronic pancreatitis was negatively associated with PEP (P < .05; OR 0.37; 95% CI, 0.15-0.93). On subset analysis, placing a prophylactic pancreatic stent was associated with significantly increased rates of PEP in patients with pancreatic duct injection compared with those who had no attempt at stent placement (P <.01). Two patients with severe pancreatitis had prophylactic pancreatic stents in place.

Limitations

Retrospective investigation.

Conclusions

In the pediatric population, pancreatic duct injection and pancreatic sphincterotomy are associated with significantly increased rates of PEP, whereas a history of chronic pancreatitis is negatively associated. Prophylactic pancreatic stenting is associated with higher rates of PEP in high-risk patients and does not eliminate severe PEP.

Section snippets

Materials and methods

With institutional review board approval, a previously created ERCP database including all patients followed by pediatric gastroenterologists at UTSW Medical Center Dallas was queried. All ERCPs were performed between January 2004 and October 2013. Informed consent before ERCP was obtained from the patient’s parent or legal guardian in all instances. Patient and procedural data were retrospectively collected to identify risk factors for PEP. Postprocedural data were reviewed up to 2 weeks after

Results

Although 436 ERCPs were identified as being performed during the study period, 4 were excluded from analysis secondary to incomplete medical records. None of these 4 patients experienced pancreatitis after the procedure. Included in analysis were 432 ERCPs on 313 patients. The median age was 12.7 years (range 1 month to 19 years). Follow-up was documented following 363 patients (84.0%). Pancreatitis was identified as an adverse event following 47 (10.9%) of the 432 ERCPs included in analysis. 

Discussion

Before this study, only 1 retrospective review specifically looked at trying to identify risk factors for the development of PEP in the pediatric population.11 The incidence of PEP in that review was low, only 2.5%, likely because the majority of cases reported were diagnostic studies and/or for biliary indications. Despite this low incidence, the authors identified performing a therapeutic case to be an independent risk factor for the development of PEP. Recent pediatric case reviews which

Conclusions

This observational study identified pancreatic duct injection and pancreatic sphincterotomy as being positively associated with the development of PEP in the pediatric population and having a history of chronic pancreatitis as being negatively associated with PEP. Although PEP is usually mild in pediatric patients, it can be moderate or severe. The criterion standard of pancreatic duct stenting for prophylaxis needs to be evaluated more closely because our study shows a positive association

References (23)

  • V.D. Morinville et al.

    Definitions of pediatric pancreatitis and survey of present clinical practices

    J Pediatr Gastroenterol Nutr

    (2012)

    • Cited by (0)

    DISCLOSURE: All authors disclosed no financial relationships relevant to this article.

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