ERCP-based management of pediatric chronic pancreatitis: Results from a retrospective long-term multicentric study

Background: Chronic pancreatitis (CP) in children causes recurrent acute episodes and ductal changes that progressively impair pancreatic function. ERCP is used to manage ductal stenosis and obstruction, but evidence in pediatric CP is limited. Aims: To assess the efficacy and safety of an ERCP-based management in children with genetically associated CP. Methods: A multicentric retrospective study was performed in Italian referral centers, including consecutive children with genetically associated CP who underwent ERCP between October 2023 and June 2024. Clinical and procedural data, and outcomes were collected. Pancreatitis incidence rates before and after ERCP (PIRpre, PIRpost) were compared. Results: Forty-two patients (mean age 8.1 ± 4.7 years; 61.9 % female) underwent ERCP, with a mean of 4.5 procedures per patient. All carried pathogenic variants, risk alleles, or VUS. Stents were placed in 34 patients, with upsizing in 41.2 %. Pancreatic duct stenosis was identified in 66.6 %. ERCP significantly reduced acute pancreatitis episodes (PIRpre 4.6 vs PIRpost 1.1; p = 0.0024), independently of stent placement. PEP occurred in 14.2 % of procedures, mostly mild; perforation, stent migration, and papillary bleeding were uncommon and managed conservatively. Mean follow-up time was 5.2 ± 2.7 years. Conclusion: ERCP significantly reduces the recurrence of pancreatitis episodes, potentially improving the quality of life.