To determine the incidence and characterise contributory risk factors for post‑ERCP pancreatitis (PEP) in patients undergoing metallic biliary stent placement at a UK tertiary hepatopancreatobiliary centre.

A retrospective review was undertaken of 217 adult patients undergoing ERCP with biliary stent placement between January 2023 and April 2025. Stents comprised fully covered self‑expandable metallic stents (FcSEMS) and uncovered SEMS (UnSEMS). Patients were observed for 20 days following ERCP. Post‑ERCP pancreatitis (PEP) was defined in accordance with the revised Atlanta criteria and ESGE guidelines.

Post‑ERCP pancreatitis (PEP) occurred in 7.83% (17/217) of patients. The cohort demonstrated a male predominance, with mean age 78.7 years. Prophylaxis with NSAIDs or GTN was administered in all cases. Distribution was comparable between fully covered SEMS (8/17) and uncovered SEMS (9/17).

Indications were dominated by complex proximal malignant strictures 76.5% (13/17), with distal strictures 17.6% (3/17) and Mirizzi syndrome 5.9%. Procedural complexity was notable: prolonged duration >15 minutes in 76.5%, difficult cannulation in 35.3% , pancreatic duct cannulation with contrast injection in 41.2% , and trainee involvement in 52.9% of the cases.

Mortality within three months of PEP was 0.51% (1/197).

Post‑ERCP pancreatitis (PEP) was observed in 7.83% of patients undergoing metallic biliary stent placement. A distinct male predominance was noted. Risk was heightened by metallic stents, pancreatic duct manipulation, and procedural complexity. Prophylaxis was near‑universal, yet procedural factors remained decisive. Prolonged duration, PD cannulation, and trainee involvement were prominent contributors. These findings underscore the need for gender‑aware risk stratification, meticulous procedural planning, and for complex ERCP procedures to be performed by expert endoscopists. Such measures may reduce PEP incidence and optimise patient outcomes.