Is Post-ERCP Pancreatitis Incidence Uniform Across the World?

Introduction: Post-ERCP pancreatitis (PEP) is one of the most dreaded complications while doing ERCP. Worldwide incidence reported to be around 7%, with majority of them being mild pancreatitis. With proper selection of cases, adequate prophylactic measures and good technique the incidence can be brought down.

Materials and methods: Retrospective analysis of 350 ERCP in a single tertiary care center between September 2021 and January 2024.

Results: 350 ERCPs were done. 60% of patients were male. Pediatric population (<15 years) constituted less than 5% of cases. Most common indications were choledocholithiasis with or without cholangitis (38%), malignant biliary obstruction (30%), pancreatic endotherapy, and post-gall bladder surgery complications. All patients received rectal indomethacin between 30 and 60 minutes of procedure. Aggressive hydration prior to procedure was not a standard practice. Cannulation of CBD was either wire-guided or after precut papillotomy. Never contrast-guided. Success rate of CBD cannulation is more than 98%. Prophylactic PD stent was placed in 16 cases. Pancreatitis, which was mild with symptoms lasting for 2 to 3 days, developed in only 5 cases. All females and one child of 7 years. All were managed with IV fluids, NBM, and analgesics. One patient developed AP during removing CBD stent.

Conclusion: In our experience, post-ERCP pancreatitis is not as common as reported worldwide. Most are easily managed and PEP need not be demonized. The reasons for the above maybe due to proper selection of cases with good technical skills. We propose, a yet to be identified, patient factor, for low incidence of PEP.

Publication History

Article published online:
22 April 2024