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Temporal trend and factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis in children in the USA: a nationwide, retrospective cohort study

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Abstract

Pancreatitis is the most common adverse event following endoscopic retrograde cholangiopancreatography (ERCP). Meanwhile, the national temporal trend of post-ERCP pancreatitis (PEP) in children remains to be reported. The purpose of this study is to investigate the temporal trend and factors associated with PEP in children. We conducted a nationwide study using data from the National Inpatient Sample database during 2008–2017 and included all patients aged ≤ 18 years who underwent ERCP. The primary outcomes were temporal trends and factors associated with PEP. The secondary outcomes were in-hospital mortality, total charges (TC), and total length of stay (LOS). A total of 45,268 hospitalized pediatric patients who underwent ERCP were analyzed; of whom, 2043 (4.5%) were diagnosed with PEP. The prevalence of PEP decreased from 5.0% in 2008 to 4.6% in 2017 (P = 0.0002). In multivariable logistic analysis, adjusted risk factors of PEP were hospitals located in the West (aOR 2.09, 95% CI 1.36–3.20; P < .0001), bile duct stent insertion (aOR 1.49, 95% CI, 1.08–2.05; P = 0.0040), and end-stage renal disease (aOR 8.05, 95% CI 1.66–39.16; P = 0.0098). Adjusted protective factors of PEP were increasing age (aOR 0.95, 95% CI 0.92–0.98; P = 0.0014) and hospitals located in the South (aOR 0.53, 95% CI 0.30–0.94; P < .0001). In-hospital mortality, TC, and LOS were higher in patients with PEP than those without PEP.

Conclusion: This study shows a decreasing national trend over time and identifies multiple protective and risk factors for pediatric PEP. Endoscopists can use the insights from this study to evaluate relevant factors before performing ERCP in children to prevent PEP and reduce the medical-care burden.

What is Known:

• Although ERCP has become indispensable procedure in children as they are in adults, education and training programs for ERCP in children are underdeveloped in many countries.

• PEP is the most common and most serious adverse event following ERCP. Research on PEP in adults showed rising hospital admission and mortality rates associated with PEP in the USA.

What is New:

• The national temporal trend of PEP among pediatric patients in the USA was decreasing from 2008 to 2017.

• Older age was a protective factor for PEP in children, while end-stage renal disease and stent insertion into the bile duct were risk factors.

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Data availability

The data used in the study is publicly available.

Abbreviations

aOR:

Adjusted odds ratio

CI:

Confidence interval

ERCP:

Endoscopic retrograde cholangiopancreatography

HCUP:

Healthcare Cost and Utilization Project

ICD-9-CM:

International Classification of Diseases, 9th revisions-Clinical Modification

ICD-10-CM:

International Classification of Diseases, 10th revisions-Clinical Modification

IQR:

Interquartile range

LOS:

Length of stay

NIS:

National Inpatient Sample

NSAIDs:

Non-steroidal anti-inflammatory drugs

OR:

Odds ratio

PEP:

Post-ERCP pancreatitis

TC:

Total charges

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Funding

The following author received research support for this study from the Three-Year Action Plan for Strengthening Public Health System in Shanghai (2020–2022) Subject Chief Scientist (grant GWV-10.2-XD05), Natural Science Foundation of Shanghai (grant 19ZR1469800): C. Wu; and the National Natural Science Foundation of China (grant 81803335): J. Xu.

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Author notes

  1. Ronghui Zhu and Shengyong Wu contributed equally to this study.

Authors and Affiliations

  1. Department of Military Health Statistics, Naval Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China

    Ronghui Zhu, Shengyong Wu, Jinfang Xu, Rui Wang, Yi Cheng, Chenxin Chen & Cheng Wu

  2. Department of Rehabilitation, Children’s Hospital of Fudan University, No. 399 Wanyuan Road, Shanghai, 201102, China

    Yetao Xu

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Contributions

Ronghui Zhu and Shengyong Wu designed the research, had full access to the data, conducted all analyses, and wrote the draft of this paper. Jinfang Xu, Rui Wang, Yi Cheng, Yetao Xu, and Chenxin Chen revised the article critically. All the authors contributed to the manuscript writing, read, and approved the final manuscript. Cheng Wu was the guarantor.

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Correspondence to Cheng Wu.

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Because the NIS databases were deidentified for public availability, our study was exempted from the requirement of institutional review board approval.

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Zhu, R., Wu, S., Xu, J. et al. Temporal trend and factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis in children in the USA: a nationwide, retrospective cohort study. Eur J Pediatr 182, 2273–2282 (2023). https://doi.org/10.1007/s00431-023-04902-8

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