SHORT-TERM RESPONSE TO THERAPEUTIC ERCP IN CHILDREN WITH ACUTE RECURRENT OR CHRONIC PANCREATITIS: AN INSPPIRE-2 STUDY

Introduction:
Treatment options for pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are limited. We have previously reported subjective pain improvement in children with ARP or CP following therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In this study, we aim to quantify the response rate to ERCP and identify the predictive factors that determine response to endoscopic therapy in children with ARP or CP.

Methods:
Data was obtained from children with ARP or CP enrolled in the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2) cohort who underwent therapeutic ERCP. ERCP response was defined as a decrease in acute pancreatitis (AP) attacks by 50% in the 1-year post-first ERCP when compared to the year pre-ERCP. Genetic and ductal risk factors (based on CT or MRI imaging within 1 year of first ERCP) were analyzed as predictive factors to determine response to therapeutic ERCP. Descriptive statistics were performed for the entire cohort. Fisher’s exact test was used to assess the association between categorical variables. Two-sample t test was used to compare continuous variables between groups.

Results:
A total of 394 children underwent a total of 1217 therapeutic ERCPs. 80 patients (21%) had ARP; 306 (79%) had CP. 141 (36.5%) had a single ERCP while 245 (63.5%) underwent multiple ERCPs. Post-ERCP pancreatitis (PEP) was observed in 3.3% (n=40). Table 1 depicts descriptive statistics for patients who underwent at least one ERCP. The mean number of ERCPs was 1.55 (IQR 1-2) in children with ARP, and 3.73 (IQR 1-4) in CP. 197 (74%) patients were responsive to therapeutic ERCP. There were significant differences in those who received ERCP versus those who did not by ductal factors (ie. Pancreatic duct dilation, duct obstruction and main pancreatic duct abnormalities) seen in Table 2.

Discussion:
Therapeutic endoscopy was commonly utilized in this largest cohort of children with ARP or CP with relatively low rates of post-ERCP pancreatitis. The majority of children with ductal risk factors responded well to the endoscopic therapy with at least 50% decrease in AP attacks the year after the initial ERCP, irrespective of the underlying risk factors. These results suggest that therapeutic ERCP may be a safe and short-term therapeutic alternative in children with ARP or CP with ductal factors seen on pre-intervention imaging.