Risk factors for post-ERCP pancreatitis: a retrospective analysis of nursing-related factors

To investigate the incidence and risk factors of endoscopic retrograde cholangiopancreatography (ERCP) post-ERCP pancreatitis (PEP) from the perspective of nursing practice, and to provide evidence for developing refined prevention and control strategies.

A single-center retrospective study was conducted on 658 patients who underwent diagnostic or therapeutic ERCP between January 2020 and December 2025. Using a nested case-control design, 45 patients who developed PEP were assigned to the case group, and 180 patients without PEP were matched at a 1:4 ratio as the control group. Baseline characteristics, procedural variables, and perioperative nursing-related factors were collected. Multivariable logistic regression analysis was performed to identify independent risk factors, and a combined prediction model was constructed to evaluate its performance.

The overall incidence of PEP was 6.8%, with mild cases accounting for 71.1%. The case group had significantly higher proportions of difficult cannulation and pancreatic duct opacification ≥ 3 times, but significantly lower proportions of receiving comprehensive nursing interventions and cooperation by a dedicated ERCP team. A higher proportion of patients in the case group were assessed as high risk preoperatively. Difficult cannulation (AOR = 6.70, 95% CI: 2.79-16.09, p < 0.001), pancreatic duct opacification ≥ 3 times (AOR = 3.38, 95% CI: 1.40-8.17, p = 0.007), and preoperative high-risk assessment (AOR = 3.98, 95% CI: 1.72-9.20, p = 0.001) were identified as independent risk factors, while comprehensive nursing interventions (AOR = 0.20, 95% CI: 0.09-0.47, p < 0.001) and dedicated ERCP team cooperation (AOR = 0.14, 95% CI: 0.05-0.37, p < 0.001) were protective factors. The combined prediction model showed good discriminative ability (AUC = 0.856) and model fit (Hosmer-Lemeshow test, p = 0.145).

Comprehensive nursing interventions and dedicated ERCP team cooperation were associated with a lower risk of PEP in this retrospective study. These findings suggest that nursing-related factors may play a role in PEP prevention. We therefore recommend integrating nursing assessment and intervention into standardized ERCP management protocols to enhance overall procedural safety.