Temporal trend and factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis in children in the USA: a nationwide, retrospective cohort study

Pancreatitis is the most common adverse event following endoscopic retrograde cholangiopancreatography (ERCP). Meanwhile, the national temporal trend of post-ERCP pancreatitis (PEP) in children remains to be reported. The purpose of this study is to investigate the temporal trend and factors associated with PEP in children. We conducted a nationwide study using data from the National Inpatient Sample database during 2008–2017 and included all patients aged ≤ 18 years who underwent ERCP. The primary outcomes were temporal trends and factors associated with PEP. The secondary outcomes were in-hospital mortality, total charges (TC), and total length of stay (LOS). A total of 45,268 hospitalized pediatric patients who underwent ERCP were analyzed; of whom, 2043 (4.5%) were diagnosed with PEP. The prevalence of PEP decreased from 5.0% in 2008 to 4.6% in 2017 (P = 0.0002). In multivariable logistic analysis, adjusted risk factors of PEP were hospitals located in the West (aOR 2.09, 95% CI 1.36–3.20; P < .0001), bile duct stent insertion (aOR 1.49, 95% CI, 1.08–2.05; P = 0.0040), and end-stage renal disease (aOR 8.05, 95% CI 1.66–39.16; P = 0.0098). Adjusted protective factors of PEP were increasing age (aOR 0.95, 95% CI 0.92–0.98; P = 0.0014) and hospitals located in the South (aOR 0.53, 95% CI 0.30–0.94; P < .0001). In-hospital mortality, TC, and LOS were higher in patients with PEP than those without PEP.

Conclusion: This study shows a decreasing national trend over time and identifies multiple protective and risk factors for pediatric PEP. Endoscopists can use the insights from this study to evaluate relevant factors before performing ERCP in children to prevent PEP and reduce the medical-care burden.