Predictors of Post-ERCP Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis.

Background And Aims: Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).

Methods: We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (OR) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.

Results: A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR: 1.81, high credibility), prior acute pancreatitis (2.59, moderate), age ≤40 (2.33, moderate), asymptomatic choledocholithiasis (4.76, low), prior PEP (4.40, low), sphincter of Oddi dysfunction (3.11, low), and female gender (1.70, low). Key procedure-related predictors of PEP were any guidewire passage into the PD (2.18, high), first ERCP with a native papilla (1.91, high), endoscopic papillary balloon dilation of an intact papilla (2.91, moderate), pancreatic acinarization (4.23, low), any PD cannulation (2.73, low), pancreatic sphincterotomy (2.64, low), difficult cannulation (2.60, low), any pancreatogram (2.40, low), and precut sphincterotomy (1.98, low).

Conclusions: Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.