Incidence and Risk Factors of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Acute Pancreatitis in a...

This study aimed to determine the incidence and factors associated with acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) in a second-level hospital in Mexico, where local data are limited compared to tertiary centres.

A single-centre retrospective study was conducted, including 52 patients with a native papilla who underwent ERCP between January and August 2024. Patients with previous ERCP, altered anatomy, or active biliary pancreatitis were excluded. Clinical and procedural variables were collected, and post-ERCP pancreatitis (PEP) was defined according to the Cotton consensus criteria (abdominal pain with amylase ≥3× upper limit of normal). Univariate and multivariate logistic regression analyses were performed to identify associated risk factors. The cumulative effect of multiple risk factors on PEP incidence was also explored. The short study period and small sample size were acknowledged as limitations that may affect generalisability.

Four cases of PEP were identified (7.7%), all classified as mild. Univariate analysis revealed significant associations with precut use (p=0.012), rectal indomethacin administration (p=0.001), and more than three cannulation attempts (p<0.001). In multivariate analysis, only >3 cannulation attempts remained statistically associated with increased PEP risk (OR 6.2; 95%CI: 1.2-33.3; p=0.032). The incidence of PEP increased progressively with the number of risk factors present (0% for none, 3.2% for one, 12.5% for two, and 25% for three), although this trend was not statistically significant due to the limited number of events. All affected patients recovered fully after conservative management, without intensive care or surgical intervention.

The observed incidence of PEP was consistent with that reported in international series. Cannulation attempts exceeding three were statistically associated with an increased risk of PEP. The apparent association of rectal indomethacin with PEP likely reflects confounding by indication, as its use was concentrated in high-risk patients. These findings highlight the need for multicentre studies to confirm these associations and reinforce the implementation of standardised prophylactic strategies, even in secondary-level hospitals.