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Visceral Adipose Tissue as an Independent Predictor of Severe Post-ERCP Pancreatitis: A Multicenter Retrospective

Shinya Uemura1, Takuji Iwashita1,2, Takuya Koizumi1

  • 1First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.

Journal of Hepato-Biliary-Pancreatic Sciences
|July 24, 2026
PubMed

Insights

High visceral adipose tissue (VAT) is linked to severe post-ERCP pancreatitis (PEP). Patients with greater VAT may face increased PEP risk after endoscopic retrograde cholangiopancreatography (ERCP).

Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Pancreatic Diseases

Background:

  • Post-ERCP pancreatitis (PEP) is a significant complication of endoscopic retrograde cholangiopancreatography (ERCP).
  • While risk factors for PEP incidence are known, those predicting severe PEP remain unclear.
  • Understanding severe PEP predictors is crucial for patient management.

Purpose of the Study:

  • To identify risk factors for severe post-ERCP pancreatitis (PEP).
  • To investigate the role of body composition, specifically visceral adipose tissue (VAT), in severe PEP.
  • To inform clinical practice regarding PEP risk stratification.

Main Methods:

  • Retrospective cohort study of 3087 patients undergoing ERCP.
  • PEP severity classified using American Society of Gastrointestinal Endoscopy criteria.
  • Body composition assessed via CT, focusing on skeletal muscle index, subcutaneous adipose tissue, and visceral adipose tissue (VAT).
  • Multivariate analysis to determine independent risk factors for severe PEP.

Main Results:

  • A total of 85 patients (2.75%) developed PEP.
  • Patients with severe PEP had significantly higher VAT compared to those with mild PEP (132.7 vs. 80.1 cm²).
  • Visceral adipose tissue (VAT) exceeding 95 cm² was the sole independent predictor of severe PEP (OR 2.79, P=0.04).

Conclusions:

  • Elevated visceral adipose tissue (VAT) is associated with an increased risk of severe post-ERCP pancreatitis (PEP).
  • Clinicians should consider high visceral adiposity as a risk factor for severe PEP during ERCP.
  • Awareness of high VAT may aid in managing patients at risk for severe PEP.
Abstract

Keywords:
ERCPbody compositionpancreatitis severitypost‐ERCP pancreatitisvisceral adipose tissue

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