Lithotripsy as risk factor of post ERCP pancreatitis; experience in a single secondary center

Aims Post ERCP Pancreatitis (PEP) is the most common complication; it is reported to occur in 3-10% of samples and up to 40% of high-risk patients. Several risk factors have also been associated with increased risk of developing PEP in numerous research studies, both patient-related (young age, female sex, suspected sphincter of Oddi dysfunction -SOD-, previous pancreatitis) and procedure-related risk factors (precut, previous sphincterotomy). The role of bile duct stone removal procedure (using basket/ balloon techniques) or biliary drainage (nasobiliary drain/stent) as PEP risk factors is lacking and not well known is the risk due to biliary mechanical lithotripsy. Our aim was to review retrospectively patient-and-procedure related risk factors for PEP and compare them with previous studies in order to identify patients and procedures at low or high risk of PEP.

Methods It was analyzed the occurrence of PEP in a series of 407 consecutives inpatients (59,4% M, 49,6 F mean age 72±13) admitted to our Gastroenterology Unit treated with ERCP for different indication (lithiasis, pancreatic cancer, stenosis) by expert interventional endoscopists between January 2020 and December 2022. ERCP procedures were reviewed in terms of indications, procedure-related complications and risk factors for complications. Difference in incidence of PEP was compared using a X2 exact test for categorical variables and logistic regression was further applied in order to predict the risk of developing PEP (statistically significant p-values<.001).

Results A total of 19 PEP cases occurred (4.7%, 13 F/6 M). PEP was classified, according to Cotton criteria, as mild (57%), moderate (34%), and severe (9%); no mortality events occurred. We found a positive correlation among PEP and SOD (OR=7.8; p<.001), previous pancreatitis (OR 7,7 p<.001) and younger age (Spearman coefficient -0.014, p<,005). Bile duct stone removal procedures were not associated with PEP (p=0.5) using either a basket or a balloon catheter (respectively p=0,3 and p=0.2). Interestingly we found a significant association with PEP and mechanical biliary lithotripsy (OR=12; p<.001). No significant differences were also found in PEP incidence among gender (p=0.1), iuxtapapillar diverticula (p=0,2), precut (p=0.6), previous sphincterotomy (p=0.8), drainage with nasobiliary drain /biliary prothesis (p=0.2).

Conclusions We found a cumulative PEP incidence similar to that in previous studies. Our data confirm SOD, previous pancreatitis and young age as risk factors for PEP as observed in the published literature. Interestingly we not found a significantly difference in the PEP incidence rate between biliary drainage or stone extraction procedures (balloon or basket catheter), but a positive correlation with mechanical lithotripsy. Further studies are needed to confirm these data.

Publication History

Article published online:
27 March 2025