Frequency and risk factors of post-ERCP pancreatitis: experience from a tertiary-care referral center in Greece

Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP, associated with significant morbidity. This study aimed to evaluate the frequency of PEP and to identify risk factors associated with its occurrence.

Methods Data from consecutive ERCPs, performed by four experienced endoscopists (between 1/2020 and 10/2022), were retrospectively analyzed. PEP was defined as the onset of abdominal pain associated with an increase (3-fold or greater) in serum amylase and severity was assessed using the revised Atlanta criteria. Difficult cannulation was defined as multiple contacts with the papilla, prolonged cannulation time or inadvertent pancreatic duct cannulation. Risk factors of PEP were evaluated using logistic regression analysis.

Results We included 142 ERCPs in 128 patients (mean age 72±15 years) with the most common indication being choledocholithiasis (84.5%). In 124/142 (87.3%) cases there was a significant (>8mm) dilatation of the common bile duct (CBD), a prior sphincterotomy in 25/142 (17.6%), whereas in 28/142 (19.7%) a periampullary diverticulum existed. Difficult cannulation was reported in 28/142 (19.7%) cases, pre-cut sphincterotomy was performed in 16/142 (11.3%) and in 14/142 (9.8%) a prophylactic pancreatic stent was placed. The incidence of PEP was 10/142 (7%), of which 9/10 were mild and 1/10 severe, with no deaths observed. Absence of significant CBD dilatation (OR=4.72, p=0.04), difficult cannulation (OR=3.50, p= 0.04) and age <70 years (OR=3.2, p=0.04) were predictors of PEP.

Conclusions In our setting, PEP occurs in 7% and it is mild in 90% of cases. Younger age, absence of significant bile duct dilatation and difficult cannulation are risk factors for its occurrence.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023