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.
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.
Authors: D Kohoutova; A Tringali; G Papparella; V Perri; I Boškoski; J Hamanaka; G Costamagna Journal: United European Gastroenterol J Date: 2018-12-05 Impact factor: 4.623
Authors: Martin Goetz; Philipp Andersen; Jacques Bergman; Nicola Frei; Arthur Schmidt; Georg Kähler; Peter Martus; Alexander Dechêne Journal: United European Gastroenterol J Date: 2019-09-03 Impact factor: 4.623
Authors: Jasmin Felux; Ekkehard Sturm; Andreas Busch; Emanuel Zerabruck; Florian Graepler; Dietmar Stüker; Andreas Manger; Hans-Joachim Kirschner; Gunnar Blumenstock; Nisar P Malek; Martin Goetz Journal: United European Gastroenterol J Date: 2017-01-11 Impact factor: 4.623