Post-ERCP Pancreatitis: Incidence, Risk Factors, and Prevention Strategies in a Romanian Tertiary Hospital

Aims Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% (or as high as 40% in high-risk patients) and a mortality rate of 1 in 500 patients [1]. Although it is receiving increasing attention due to the rise of the ERCPs performed in recent years, the etiopathogenesis of post-ERCP pancreatitis (PEP) remains poorly understood [2]. The aim of this study is to analyze the incidence of PEP and to identify potential patient- and procedure-related risk factors in a cohort of patients from a tertiary referral center in Romania.

Methods We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2020 and August 2024. We collected data prior to, during, and 24–72 hours after the procedure. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer’s solution after the procedure in the absence of contraindications, according to the latest international recommendations. We diagnosed PEP if the patient presented abdominal pain indicative of acute pancreatitis and had serum lipase levels at least three times higher than the upper limit of normal. We did not performed a routine cross-sectional imaging for diagnostic purposes. Risk factors were identified by univariate and multivariate regression analyses.

Results In total, 2289 ERCPs were performed on 2082 patients. PEP occurred in 350 (15,29%) of the cases, involving 346 patients, 4 of whom developed multiple episodes during different hospital visits. Of these, 160 (45,71%) were males, with a mean age of 66,43 years. We classified 337 (96,28%) of the cases as mild, 9 (2,57%) as moderate, and 4 (1,14%) as severe PEP. 15 patients (4,33%) needed a prolongation of hospital stay, and 2 patients died as a result of complications. Procedure-related independent risk factors with adjusted odds ratios (OR) were: difficult canulation of the common bile duct (CBD) (lasting>10 min) (OR 3.317), Wirsung duct cannulation and pancreatography (OR 1.912), and pre-cut sphincterotomy (OR 2.133). We identified no prior history of ERCP (OR 1.745) and type 2 diabetes mellitus (OR 1.449) as patient-related independent risk factors. We did not identify female gender and age under 60 years old as significant risk factors for PEP. Prophylactic pancreatic duct stent placement was shown to prevent PEP in this study group (p=0.03).

Conclusions PEP remains a serious complication of ERCP, associating significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, the present study emphasizes that patient selection and technical aspects, such as successful and efficient CBD canulation, avoiding Wisung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.

Publication History

Article published online:
27 March 2025

• References

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• 2 He QB, Xu T, Wang J, Li YH, Wang L, Zou XP.. Risk factors for PEP and hyperamylasemia. Journal of Digestive Diseases 2015; 16: 471-478