Identification of risk factors associated with post-ERCP pancreatitis in patients with easy cannulation: A prospective multicenter observational study

Background and aims: Difficult biliary cannulation is an independent risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP); however, there is a noticeable lack of studies focusing on the incidence and risk factors of PEP among patients undergoing easy cannulation. Therefore, we aimed to systematically investigate the risk factors for PEP in patients who underwent easy cannulation.

Methods: We prospectively enrolled patients with naïve major papillae who underwent diagnostic or therapeutic ERCP between June 2018 and June 2023. The primary endpoint was to determine the incidence of PEP in patients with easy cannulation; the secondary endpoints included identifying PEP risk factors and evaluating procedure-related adverse events (AEs).

Results: Overall, 1,930 patients were included, with 1,061 (54.9%) undergoing easy cannulation. Within this cohort, PEP incidence was 3.0%, whereas 2.9% experienced procedure-related AEs, excluding PEP. A history of acute pancreatitis (odds ratio [OR] 95% confidence interval [CI]: 6.75 [1.83-20.14], P=0.001) and acute cholangitis upon admission (OR [95% CI]: 2.25 [1.07-5.08], P=0.039) were identified as independent risk factors for PEP in patients with easy cannulation. Endoscopic sphincterotomy and biliary stent placement were independent factors for procedure-related AEs.

Conclusions: Our findings underscore the importance of assessing patient- and procedure-related factors to mitigate the risk of PEP in patients undergoing easy cannulation. Despite the low incidence of PEP, the potential for the occurrence of severe cases emphasizes the need for cautious intervention, particularly in patients with a history of acute pancreatitis and acute cholangitis upon admission.