Age-associated outcomes of ERCP in pediatric chronic pancreatitis.

BACKGROUND: Pediatric chronic pancreatitis (CP) is associated with significant morbidity and nutritional challenges, yet the impact of endoscopic retrograde cholangiopancreatography (ERCP) on clinical and nutritional outcomes in children remains incompletely defined. This study aimed to evaluate age associated outcomes following ERCP in children. METHODS: We conducted a retrospective cohort study of 154 pediatric patients who underwent 360 ERCP procedures between 2019 and 2024 with age-stratified analyses. The primary outcomes included the rate of pre-discharge pain relief, defined as a discharge Visual Analogue Scale (VAS) score <4, the incidence of post-ERCP pancreatitis (PEP), and changes in body mass index (BMI). Nutritional status was assessed using BMI, weight-for-age Z-scores, and vitamin D levels. Follow-up data were available for 134 patients (87%) at ≥2 years. Secondary outcomes included recurrent pancreatitis within 2 years after ERCP, nutritional evolution, and pancreatic function. RESULTS: High rates of nutritional abnormalities were observed, including vitamin D deficiency (61.2%), undernutrition (18%), and overweight/obesity (5.2% & 5.2%). ERCP technical success was 99.17%. In this chronic pancreatitis-only cohort, PEP occurred after 111 of 360 procedures (30.8%) and was more frequent in preschool-aged than school-aged children (35.13% vs. 27.8%, P = 0.023). School-aged children showed a higher pre-discharge pain relief rate and significant VAS score reduction, whereas preschool-aged children had higher PEP rates and less statistically evident VAS score improvement. BMI showed an increasing trend mainly in school-aged children, with no significant change in preschool-aged children. CONCLUSIONS: ERCP appears feasible in pediatric CP, with high technical success and predominantly mild complications. Age was associated with differences in pain relief and PEP risk. Nutritional findings should be interpreted cautiously as a limited longitudinal signal rather than definitive improvement. IMPACT: Patient age was associated with differences in ERCP-related outcomes in pediatric chronic pancreatitis. School-aged children showed a higher pre-discharge pain relief rate, whereas preschool-aged children showed higher PEP rates and less statistically evident VAS score improvement, suggesting the need for careful age-specific risk assessment. To our knowledge, this is one of the largest age-stratified studies evaluating ERCP-related clinical and nutritional outcomes in pediatric chronic pancreatitis. These findings may support age-specific risk assessment, closer monitoring of younger children, and more individualized nutritional follow-up after ERCP.