Aims
This study aimed to determine the incidence, severity, and predictors of Post ERCP induced pancreatits(PEP) in a tertiary care center in North India.
Methods
This retrospective observational study included 300 consecutive ERCPs performed between January 2024 and August 2025 at the Department of Gastroenterology, Himalayan Institute of Medical Sciences, Dehradun. Data on demographics, indications, cannulation difficulty, prophylaxis, and outcomes were analyzed. PEP was defined as new or worsened abdominal pain with serum amylase/lipase more than 3 times upper limit of normal within 24 hours, requiring ≥2 days of hospitalization(1). Severity was classified as per the Revised Atlanta Criteria.
Results
Among 300 ERCPs done , mean patient age was 52 ± 10 years, with 60% female patients. Common indications included CBD stones (70%), cholangitis (15%), benign strictures (10%), and malignant obstruction (5%). Prophylaxis included rectal NSAIDs in 65% and pancreatic duct stenting in 12%. The overall incidence of PEP was 8% (n=24): mild (n=16), moderate (n=5), and severe (n=3). Difficult cannulation (>5 attempts) and inadvertent PD injection were significant predictors (p<0.05). No mortality occurred in the study.
Conclusions
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most frequent complication of ERCP, despite advances in prophylactic strategies(1). The incidence of PEP in this cohort was comparable to global data as seen in freeman et al study (2). Difficult cannulation and Pancreatic duct injection were key risk factors for PEP in our study . Rectal NSAIDs demonstrated a protective effect in prevention of PEP. Similar results were seen in Dumonceau et al study(1).Adherence to ESGE-recommended prophylactic measures can further minimize PEP rates.(3)