Analysis of Risk Factors for Post-ERCP Pancreatitis in Patients with Cholangiocarcinoma

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for cholangiocarcinoma and often involves multiple procedures, potentially increasing the risk of post-ERCP pancreatitis (PEP). However, PEP characteristics in cholangiocarcinoma patients remain unclear. This study aimed to assess the incidence and diagnostic procedure-specific risk factors for PEP in patients with cholangiocarcinoma. Methods: We retrospectively reviewed 218 ERCP procedures for cholangiocarcinoma performed at our hospital between January 2017 and March 2022. The incidence of PEP, severe PEP, and fatal PEP was recorded. Risk factors for PEP were analyzed using multivariate analysis, and severe cases were further evaluated. Results: Among the 218 patients, 15 (6.9%) developed PEP, 4 (1.8%) had severe PEP, and 2 (0.9%) died. Multivariate analysis identified the pancreatic guidewire technique (PGW) (OR: 8.18; 95% CI: 2.52-26.53, p < 0.001) and intraductal ultrasonography (IDUS) (OR: 6.53; 95% CI: 2.01-21.25, p = 0.002) as significant risk factors. Both fatal cases involved naïve papilla and PGW and IDUS, with no pancreatic duct stent placement. Conclusions: ERCP for cholangiocarcinoma carries a clinically relevant risk of severe or fatal PEP. In particular, ERCP-specific diagnostic procedures required for cholangiocarcinoma may confer a disease-specific risk profile distinct from that of general ERCP. PGW and IDUS were identified as major risk factors, especially in patients with a naïve papilla, in whom prophylactic pancreatic duct stenting should be considered to reduce the risk of severe or fatal outcomes.