Impact of ERCP on pancreatitis frequency in pediatric acute recurrent or chronic pancreatitis: An INSPPIRE‐2 study

OBJECTIVES: Treatment options for pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are limited. We aim to quantify the response rate to endoscopic retrograde cholangiopancreatography (ERCP) and identify predictive factors that determine response in children with ARP or CP. METHODS: Data was obtained from the INternational Study Group of Pediatric Pancreatitis: In search for a cu RE-2 cohort who underwent ERCP. ERCP response was defined as a decrease in acute pancreatitis (AP) attacks by 50% in the year after first ERCP, compared to the year before this ERCP. Fisher's exact test was used to assess associations between categorical variables and Wilcoxon rank-sum test or two-sample t-test for continuous variables. RESULTS: There were 436 children who underwent a total of 1504 ERCPs in our cohort. Eighty-five patients (19.5%) had ARP; 351 (80.5%) had CP. Significant differences were noted between those who had ERCP and those who did not based on sex, BMI percentile and diagnosis. ERCP response rate was 70.0% (n = 206). Patients with pancreatic duct calculi/obstruction were more likely to be ERCP responders (p < 0.04). CONCLUSIONS: ERCP was used commonly in the treatment of ARP/CP for children with any pancreatic duct abnormality. Two-thirds of children responded well to endoscopic therapy with at least 50% decrease in AP attacks the year post-initial ERCP; ductal calculi/obstruction were associated with higher rate of response. These results support that therapeutic ERCP is safe and may provide short to medium-term therapeutic benefit in children with ARP or CP especially with ductal factors seen on pre-intervention imaging.