Related Experiment Video
Updated: Sep 20, 2026
Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis
Published on: December 14, 2019
Fatty Pancreas and the Association Between Pancreatic Manipulation Burden and Post-ERCP Pancreatitis
Yanyan Liu1,2, Jiaqing Yu1,2, Qi Zhang1
1Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao, 266075, China.
Background:
Fatty pancreas has been associated with pancreatitis after ERCP, but its interaction with procedure-related pancreatic injury is unknown.
Aims:
We evaluated whether fatty pancreas modified the association between cumulative pancreatic manipulation and postprocedural pancreatitis.
Methods:
This multicenter retrospective cohort included 679 patients with native papillae undergoing biliary endoscopic retrograde cholangiopancreatography. Fatty pancreas was defined as a pancreas-to-spleen attenuation ratio < 0.7 on preprocedural noncontrast computed tomography. A pancreatic manipulation burden score (range, 0 - 4) assigned one point each for difficult biliary cannulation, double-guidewire technique, pancreatic duct opacification, and transpancreatic sphincterotomy. Multivariable regression assessed main effects and interaction; marginal standardization estimated adjusted risks.
Results:
Fatty pancreas was present in 183 patients (27.0%), and 67 (9.9%) developed pancreatitis. Fatty pancreas (adjusted odds ratio, 2.17; 95% confidence interval, 1.27 - 3.73) and each one-point score increase (adjusted odds ratio, 1.53; 95% confidence interval, 1.26 - 1.86) were associated with pancreatitis. In the continuous interaction model, the adjusted per-point score odds ratio was 1.28 (95% confidence interval, 0.98 - 1.68) without fatty pancreas and 2.08 (95% confidence interval, 1.52 - 2.84) with fatty pancreas (interaction odds ratio, 1.62; 95% confidence interval, 1.07 - 2.46; P = 0.023). The categorical analysis yielded directionally concordant interaction estimates but was not statistically significant (P = 0.067). Sensitivity analyses were directionally consistent.
Conclusions:
Computed tomography-defined fatty pancreas was associated with post-ERCP pancreatitis, and the interaction analyses suggest that the association between manipulation burden and post-ERCP pancreatitis may differ according to fatty pancreas status. Larger prospective studies are needed to validate these findings.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:25Chronic Pancreatitis I: Introduction
01:25Acute Pancreatitis I: Introduction
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:26Endoscopic Procedures V: ERCP
Patient...