Post-ERCP pancreatitis (PEP) remains the most frequent and potentially severe adverse event of ERCP. Identifying patient and procedure related risk factors is essential to improve practice and reduce morbidity. We aimed to describe our institutional experience and assess potential predictors of PEP.

We conducted a retrospective single-center study over 12 months (January–December 2024). All hospitalized patients undergoing ERCP were included. PEP was diagnosed according to clinical and biochemical criteria. Collected variables comprised patient-related data (age, sex, prior pancreatitis, bilirubin level, suspected sphincter of Oddi dysfunction) and procedure-related factors (papillary anatomy, difficulty of cannulation, inadvertent pancreatic duct opacification, prophylactic measures). Severity was assessed using SIRS criteria and CT (Balthazar classification)

Among 209 ERCPs, 13 PEP cases were identified (incidence 6.22%). Mean age was 38 years (23–53), with a predominance of females (sex ratio 3.3). A history of acute pancreatitis was absent in 89.7%. Bilirubin levels were normal in 50%. Peri-diverticular papilla was present in 23.07%. Difficult biliary cannulation occurred in 46.15%, and pancreatic duct opacification in 38.46%. Prophylactic pancreatic stenting was used in 30.76%. All patients received rectal NSAIDs. SIRS was observed in 30.76% of cases (Balthazar grade E). Clinical outcome was favorable in all patients, with 82.9% hospitalized for 4–10 days.

PEP remains unpredictable but potentially preventable. Optimized patient selection, improved technical proficiency, and systematic use of evidence-based prophylaxis including rectal NSAIDs and pancreatic stents may significantly reduce its incidence.