Association of Fatty Liver with Development of Post-ERCP Pancreatitis in Biliary Stone Disease

Aims Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment to relieve biliary stone obstruction. Post-ERCP pancreatitis (PEP) is the most frequent adverse effect associated with ERCP. This study was aimed to determine the association of fatty liver with development of PEP.

Methods A retrospective analysis of all the patients who underwent their index ERCP for biliary stone disease between January 2022 and December 2023 was performed. Diclofenac suppository was placed in all the patients at the time of ERCP unless contraindicated. Patients who had abdominal imaging (Ultrasound or Computerised Tomography) mentioning liver echogenicity or steatosis were included. We excluded patients with chronic pancreatitis and those undergoing ERCP for biliary pancreatitis. Demographics, clinical presentation, and ERCP details were recorded. The outcomes studied were risk factors and the incidence of PEP in patients with and without fatty liver.

Results A total of 304 patients underwent index ERCP during the study period for biliary stone disease met inclusion criteria. PEP occurred in 24 (7.89%) patients. In the multivariate risk model, significant risk factors for PEP were young age (age<55 years) [OR: 3.49, 95% CI: 1.23-9.84, p=0.018],≥1 pancreatic duct cannulation [OR: 10.03, 95% CI: 3.75-26.87, p<0.005] and presence of fatty liver [OR: 2.89, 95% CI: 1.09-7.63, p=0.033].

Sixty seven patients (Females: 30, mean age: 52.53 years) with fatty liver were compared with 237 patients (Females: 115, mean age: 50.89 years) without fatty liver. PEP was observed more frequently in patients with fatty liver compared to those without fatty liver [14.9% vs. 5.9%, p=0.022]. Risk factors for PEP like young age, female sex,≥1 pancreatic duct cannulation, pre-cut technique of cannulation, sphincteroplasty, trainee involvement were found to be similar in those with and without fatty liver.

Conclusions Patients with fatty liver had more than two-fold increased risk of PEP while undergoing ERCP for biliary stone disease. Further studies to evaluate the etiopathogenesis of PEP in patients with fatty liver and the role of additional preventive strategies are needed.

Publication History

Article published online:
27 March 2025