135 ERCP in Young Adults (<35 Years): A 14-Year Retrospective Analysis of Indications, Interventions, and Outcomes

Abstract Background ERCP is a technically demanding endoscopic procedure. Its role in patients under 35 years remains controversial. This study evaluates the indications, interventions, and outcomes of ERCP in this younger cohort. Method A retrospective review was conducted of patients aged <35 years who underwent ERCP between 2011 and 2024 at multiple hospitals. Demographics, indications, sphincter interventions, stenting, complications, length of hospital stay, and need for repeat procedures were analysed. Results 149 patients (84% female) were included (mean age 22.5 ± 3.2 years, mean follow-up 13.2 months). Common indications were CBD stones (55%), missed/retained stones (16.77%), bile leak (9%), failed laparoscopic CBD exploration (9%), and benign stricture (5%). Sphincterotomy was performed in 77%, both sphincterotomy and sphincteroplasty in 14%, and isolated sphincteroplasty in 5%. Biliary stents were used in 24% (11 metal, 25 plastic). Pancreatic duct PD cannulation/stenting was performed in 26%. Post-ERCP pancreatitis PEP occurred in 11.4%, bleeding in 2%, and perforation in 1%. Thirty-seven patients (25%) required repeat ERCP or further intervention. The median hospital stay was 1 day (IQR: 1–3, mean 3.1 days, max 82). Pancreatic duct cannulation was significantly associated with PEP (p=0.016). Sphincter intervention type (Sphincterotomy) was significantly associated with pancreatitis (p<0.001). Biliary stenting was significantly associated with need for repeat procedures (p<0.001). Conclusions ERCP is increasingly performed in young adults, mainly for choledocholithiasis. This study finds a higher than average PEP rate with one in four required re-intervention. PD cannulation, biliary stenting, and sphincter intervention significantly associated with adverse outcomes.