Risk factors for post-ERCP pancreatitis: a prospective multicenter study in upper Egypt

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) has become widely available for diagnosis and treatment of pancreatic and biliary diseases. Pancreatitis is the most common and serious complication to occur after ERCP resulting in substantial morbidity and occasional mortality. The aim of this study was to evaluate the potential patient and procedure-related risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in a prospective multicenter study. Patients and methods Consecutive ERCP procedures were prospectively studied at five centers (two universities, three private). Data were collected on patient characteristics and endoscopic techniques before the procedure, at the time of procedure, and 24-72 h after discharge. PEP was diagnosed and its severity graded according to consensus criteria. Results Pancreatitis occurred after 104 (8.9%) of 1162 consecutive ERCP procedures and was graded mild in 66 (63.5%), moderate in 30 (28.8%), and severe in eight (7.7%) cases. On univariate analysis, 11 of 18 evaluated variables were found to be significantly associated with PEP. On multivariate analysis, significant risk factors with adjusted odds ratio (OR) were: difficult cannulation (OR: 10.2), previous PEP (OR: 8.1), previous pancreatitis (OR: 7.9), at least two pancreatic duct injections (OR: 3.1), pancreatic duct cannulation (OR: 2.7), difficult stone extraction (OR: 2.2), and precut sphincterotomy (OR: 1.2). Conclusion Technique-related risk factors are probably more numerous and potent than patient-related ones in determining high-risk predictors for PEP.