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Does Fatty Pancreas Matter? Evaluating the Risk of Post-ERCP Pancreatitis in Patients with Pancreatic Steatosis: A
Vasileios Lekakis1, Margarita Papatheodoridi2, George V Papatheodoridis2
1First Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 17 Agiou Thoma Street, 11527, Athens, Greece. lekakis.vas@gmail.com.
Background:
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a frequent and clinically significant complication. Pancreatic steatosis (PS), an increasingly common imaging finding associated with obesity, metabolic syndrome, and diabetes, may predispose the pancreas to injury during ERCP; however, its association with the risk of PEP remains uncertain.
Aim:
To systematically evaluate the association between pancreatic steatosis and the risk and severity of PEP.
Methods:
Systematic review and meta-analysis were conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane databases were searched through May 2025 for studies comparing PEP incidence in patients with and without PS. Pooled relative risks (RRs) were calculated using random-effects models. Subgroup analyses examined the impact of demographic factors, procedural variables, and diagnostic indications.
Results:
Four studies involving 2108 patients were included. PS was associated with a significantly increased risk of PEP [Relative Risk (RR): 2.69; 95% confidence interval: 1.86-3.90; p = 0.32), with an incidence of 12% in patients with PS compared to 6% in those without. PS was also linked to higher risk of mild (RR: 2.25), moderate (RR: 4.73), and severe PEP (RR: 4.54). Compared to non-PS, patients with PS had higher prevalence of diabetes (RR: 1.41) and female sex (RR: 1.15). No significant differences in procedural variables or diagnostic indications were observed between the PS and non-PS groups.
Conclusion:
Pancreatic steatosis is associated with an increased risk and severity of PEP. Further high-quality prospective studies are warranted to validate this association and determine whether PS should be incorporated into pre-procedural risk stratification and targeted preventive strategies.
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