Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography

Abstract

Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; p = .01) and hospital day (18 vs. 6 days; p = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; p = .04), overall biliary cannulation time >10 min (61.9% vs. 38.1%; p = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; p = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (p = .01). Overall biliary cannulation time >10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; p = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; p = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time >10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.