Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Table 1 Risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography n (%)

	No pancreatitis	Pancreatitis	P-value
	894 (89.9)	102 (10.2)
Patient related factors
Median age (yr)	60	48	0.0001
Age group
< 35	32 (7.2)	20 (39.2)	0.0001
> 35	415 (92.8)	31 (60.8)
Sex
Male	510 (57)	44 (43.1)	0.05
Female	384 (43)	58 (56.9)
Median serum bilirubin (mg%)	10.6	12.5	0.76
< 2	124 (88.6)	16 (11.4)
> 2	770 (90)	86 (10)	0.72
Median CBD diameter (mm)	16	10	0.0001
< 10	70 (7.8)	58 (56.9)
> 10	824 (92.2)	44 (43.1)	0.0001
Indication for ERCP
Malignant	402 (45)	40 (39.2)	0.43
Benign	492 (55)	62 (60.8)
Type of papilla
Normal	540 (60.4)	56 (54.9)	0.01
Atrophic	18 (2)	8 (7.8)
Pregnant	68 (7.6)	2 (2)
Tumour	64 (7.2)	4 (3.9)
Redundant	66(7.4)	12 (11.8)
Juxtadivericular	68 (7.6)	16 (15.7)
Small	60 (6.6)	2 (2)
Long	10 (1.1)	2 (2)
Procedure related factors
Number of cannulation attempts
< 5	660 (73.9)	58 (56.9)	0.01
≥ 6	234 (26.1)	44 (43.1)
Number of pancreatic cannulations	0	2	0.0001
< 3 times	864 (96.6)	60 (58.8)
> 3 times	28 (3.4)	42 (41.2)	0.0001
Method of cannulation
Conventional	640 (89.4)	76 (10.6)	0.7
Precut	252 (90.6)	26 (9.4)
Biliary sphincter balloon dilatation
No	654 (73.2)	86 (84.3)	0.08
Yes	240 (26.8)	16 (15.7)

CBD: Common bile duct; ERCP: Endoscopic retrograde cholangiopancreatography

Table 2 Predictors of severity of pancreatitis after endoscopic retrograde cholangiopancreatography n (%)

	Mild to moderate pancreatitis (80)	Severe pancreatitis (22)	P-value
Patient related factors
Median age (yr)	52	30	0.0001
Age
< 35	26 (32.5)	14 (63.6)	0.0001
> 35	54 (67.5)	8 (36.4)
Sex
Male	38 (47.5)	6 (27.3)	0.08
Female	42 (52.5)	16 (72.7)
Median serum bilirubin (mg%)	14.1	9.9	0.3
< 2	8 (50)	8 (50)
> 2	72 (85.7)	14 (14.3)	0.07
Median CBD diameter (mm)	10	9	0.0001
< 10	42 (52.5)	16 (72.7%)
> 10	38 (47.5)	6 (27.3%)	0.0001
Indication for ERCP
Malignant	39 (97.5)	1 (2.5)	0.009
Benign	41 (66.1)	21 (33.9)
Type of papilla
Normal	39	17	0.06
Atrophic	6	2
Pregnant	0	2
Tumour	4	0
Redundant	9	3
Juxtadivericular	15	1
Small	2	0
Long	2	0
Procedure related factors
No. of cannulation attempts
< 5	46 (57.5)	12 (54.5)	0.03
≥ 6	34 (27.5)	10 (45.5)
Median number of pancreatic cannulations	2	4	0.0001
< 3 times	58 (72.5)	2 (9.1)	0.0001
> 3 times	22 (52.4)	20 (90.9)
Method of cannulation
Conventional	58 (72.5)	18 (81.8)	0.07
Precut	22 (52.4)	4 (18.2)
Biliary sphincter balloon dilatation
No	70 (87.5)	16 (72.7)	0.1
Yes	10 (12.5)	6 (27.3)

CBD: Common bile duct; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Multivariate logistic regression for analysis of pancreatitis after endoscopic retrograde cholangiopancreatography

Variable	P-value	Odds ratio	95%CI for EXP(B)
			Lower	Upper
Age group	0.001	0.035	0.005	0.259
Age	0.519	1.012	0.976	1.050
Sex	0.362	0.143	0.075	0.270
CBD diameter below 10 mm	0.609	0.726	0.212	2.481
CBD diameter	0.000	0.612	0.495	0.757
Difficult cannulation	0.207	0.476	0.150	1.506
No. of pancreatic cannulations below 3	0.117	0.219	0.033	1.460
No. of pancreatic cannulations	0.000	5.258	2.665	10.370
Papilla	0.964

CBD: Common bile duct.