Risk Factors for Post-ERCP Pancreatitis and Assessment of Stent Exchange Intervals in Children with Chronic Pancreatitis

Background Endoscopic retrograde pancreatic drainage (ERPD) is a first-line therapy for pediatric chronic pancreatitis (CP), but pediatric-specific risk factors for post-ERCP pancreatitis (PEP) and optimal stent exchange intervals remain undefined. Methods In this single-center retrospective study, 51 pediatric CP patients (≤ 14 years) undergoing 131 ERPD procedures (2015–2024) were enrolled. PEP was diagnosed per ESGE 2020 criteria (new/worsened abdominal pain + amylase/lipase > 3×ULN). Univariate and multivariate logistic regression identified PEP risk factors. Stent exchange intervals (≤ 6 vs. >6 months) were compared for symptoms and acute pancreatitis occurrence. Results A cohort of 51 pediatric CP patients underwent 131 successful ERPD procedures. PEP occurred in 23 procedures (17.6%), all classified as mild and managed conservatively without severe complications. Univariate and multivariate logistic regression identified that pancreaticobiliary maljunction (PBM) (OR = 5.220, 95% CI: 1.015–26.850, P =  0.048) and small stent diameter (≤ 5 Fr) (OR = 3.317, 95% CI: 1.033–10.649, P =  0.044) as independent risk factors for PEP. No significant differences were observed in interval symptoms (short-interval: 22.7% vs. long-interval: 27.6%, P =  0.693) or acute pancreatitis episodes (9.1% vs. 10.3%, P =  0.881) between groups. Conclusions PBM and small stent diameter (≤ 5 Fr) are independent risk factors for PEP in CP children. Extending stent exchange intervals beyond 6 months does not increase symptoms or acute pancreatitis risk, suggesting it may be safe to individualize replacement timing to reduce procedural burden.