Real-World Incidence of Post-ERCP Pancreatitis (PEP) from a North Indian Tertiary Care Hospital

Background and Aim: The incidence, severity, and mortality of post ERCP pancreatitis (PEP) largely remain unknown especially in Indian settings. This study analyzed the incidence, severity, and mortality of PEP in our normal risk and high-risk ERCP patients in last one and half year in Yashoda Super Specialty Hospital, Kausambi, Ghaziabad, Uttar Pradesh, India.

Methods: All consecutive ERCP procedures (n = 108) done in Yashoda Super Specialty Hospital, Kaushambi, Ghaziabad were retrospectively studied from May 2022 till January 2024. The incidence, severity, and risk factors for PEP were evaluated immediately postprocedure and at Day 30 using established consensus criteria.

Results: Of 101 successful ERCP procedures, PEP occurred in 4 patients (4%); it was mild in 3 patients, moderate in 1 patient, and severe in none of the patients. High-risk factors were present in 64% (n = 64/101) patients ([Table 1]). Number of patients having one risk factor was 50.9% (n = 55), while 8.3% (n = 9) had two risk factors and none of patients had 3 or more risk factors. The incidence of PEP in benign causes was lower compared to other studies and meta-analysis. Possible reasons could be that most of our cases were CBD stones/sludge/bile duct injury, while the number of malignant biliary obstruction (MBO) was low.

Conclusion: Incidence of PEP in our ERCP series from a tertiary care hospital in North India was 4%.

Table 1 Outcome distribution

Outcome	n (%)	Mean ± SD	Median (25th–75th percentile)	Range
Primary outcome after drain of abscess
Improved	65 (91.55%)	–	–	–
Necrosectomy	4 (5.63%)
PCD done	1 (1.41%)
Persistent collection	1 (1.41%)
Follow-up
Stable	70 (98.59%)	–	–	–
Deteriorated	1 (1.41%)
EUS/imaging on first follow-up (removal of LAMS)
Resolution	54 (76.05%)	–	–	–
Improved	10 (14.04%)
Persistent collection	7 (9.86%)
Surgery
None	52 (73.24%)	–	–	–
Lap cholecystectomy	13 (18.31%)
Laparoscopic necrosectomy	1 (1.41%)
Open necrosectomy	2 (2.82%)
Open cholecystectomy	1 (1.41%)
Parathyroidectomy	1 (1.41%)
USG guided PCD and necrosectomy	1 (1.41%)
Day of pancreatitis on which LAMS was inserted	-	43.75 ± 18.03	40 (33–46.5)	24–130

Abbreviations: LAMS, lumen-apposing metal stents; PCD, percutaneous drainage; USG, ultrasonography.

Publication History

Article published online:
22 April 2024