Risk factors for post-ERCP pancreatitis and assessment of stent exchange intervals in children with chronic pancreatitis: a single-center retrospective study

BACKGROUND: ERPD serves as the first-line endoscopic interventional therapy for pediatric chronic pancreatitis (CP). However, pediatric-specific risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and the optimal stent exchange intervals remain poorly defined. METHODS: In this single-center retrospective study, pediatric CP patients (≤ 14 years) undergoing ERPD procedures (2015-2024) were enrolled. PEP was diagnosed per ESGE 2020 criteria (new/worsened abdominal pain + amylase/lipase > 3×ULN). Univariate and multivariate logistic regression identified PEP risk factors. Stent exchange intervals (standard interval vs. long interval) were compared for symptoms and acute pancreatitis occurrence. RESULTS: A cohort of 51 pediatric CP patients underwent 131 successful ERPD procedures. PEP occurred in 23 procedures (17.6%), all classified as mild and managed conservatively without severe complications. Univariate analysis revealed potential associations between PEP and several variables and multivariate analysis identified that pancreaticobiliary maljunction (PBM) (Adjusted OR = 4.861, 95% CI: 1.143-20.716, P = 0.032) and small stent diameter (≤ 5 Fr) (Adjusted OR = 3.083, 95% CI: 1.163-9.495, P = 0.047) were associated with increased PEP risk. No significant differences were observed in interval symptoms (standard interval: 22.7% vs. long interval: 27.6%, P = 0.693) or acute pancreatitis episodes (9.1% vs. 10.3%, P = 0.881) between the two groups. CONCLUSIONS: PBM and small stent diameter (≤ 5 Fr) are associated with increased PEP risk, although causality cannot be established. Extending stent exchange intervals beyond 6 months does not increase the risk of symptoms or acute pancreatitis. Individualizing stent replacement schedules to lower procedural burden appears feasible, which requires further validation in prospective studies.