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ERCP Associated with Reduced Recurrence of Pancreatitis, Suggests Study
Italy: Researchers have found in a new study that endoscopic Retrograde Cholangiopancreatography (ERCP) significantly lowers the recurrence of pancreatitis episodes. By addressing underlying biliary or pancreatic ductal causes, ERCP can help prevent repeated attacks, thereby reducing hospitalizations and potentially improving patients’ overall quality of life.
The findings, published in Digestive and Liver Disease, come from a long-term, multicentric retrospective study led by Simona Faraci from the Gastroenterology and Nutrition Unit at Bambino Gesù Children’s Hospital, IRCCS, Rome, and colleagues across Italian referral centers. The study evaluated the effectiveness and safety of ERCP in children with genetically associated chronic pancreatitis (CP), a rare but debilitating condition marked by recurrent inflammation and progressive pancreatic damage.
The analysis included 42 children (mean age 8.1 years; 61.9% female), all carrying pathogenic genetic variants or variants of uncertain significance linked to CP. The most commonly identified mutations involved the CFTR and PRSS1 genes. Recurrent abdominal pain was the most frequent presenting symptom, followed by acute pancreatitis episodes. Before undergoing ERCP, patients experienced a mean of 5.5 pancreatitis episodes over approximately eight years.
The researchers reported the following findings:
- Each child underwent at least one ERCP, with a mean of 4.5 procedures per patient.
- Pancreatic duct stenosis was detected in nearly two-thirds of cases.
- Stents were placed in 34 patients, with progressive upsizing in over 40% to maintain ductal patency.
- Clinical improvement was observed irrespective of stent placement, highlighting the role of sphincterotomy and ductal decompression in symptom control.
- In 23 patients with complete follow-up, pancreatitis incidence significantly declined after ERCP.
- The mean episode rate reduced from 4.6 before ERCP to 1.1 after the procedure.
- Mean follow-up exceeded five years, indicating sustained clinical stability.
- No deaths or cases of insulin-dependent diabetes were reported during follow-up.
- Seven children required pancreatic enzyme replacement therapy due to exocrine insufficiency.
- Post-ERCP pancreatitis occurred in 14.2% of procedures, mostly mild in severity.
- Other complications, including ductal perforation, stent migration, and papillary bleeding, were rare and managed conservatively.
- ERCP in children requires specialized expertise due to technical complexity and the need for pediatric-specific equipment.
While the retrospective design and absence of standardized quality-of-life assessments limit the study, the consistent reduction in acute episodes supports ERCP as an effective, minimally invasive strategy in pediatric CP. The researchers conclude that when performed in experienced referral centers, ERCP not only treats complications but may also modify disease progression, potentially delaying the need for surgical intervention in this high-risk population.
Reference:
Faraci, S., Rollo, G., Alghisi, F., Romano, C., Gismondi, A., Sepe, A. O., Cristiani, L., Labriola, F., Bramuzzo, M., Torroni, F., Mandato, C., Dall'Oglio, L., Caldaro, T., De Angelis, P., & Balassone, V. (2026). ERCP-based management of pediatric chronic pancreatitis: Results from a retrospective long-term multicentric study. Digestive and Liver Disease. https://doi.org/10.1016/j.dld.2026.02.005
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