Post-ERCP pancreatitis (PEP) represents the most common complication of ERCP (Endoscopic Retrograde CholangioPancreatography). This is a clinically relevant issue, given its non-negligible mortality rate and the substantial costs associated with the management of this complication. This study aims to retrospectively evaluate the risk and protective factors associated with post-ERCP pancreatitis (PEP) in a patient cohort, and to compare the findings with those reported in the literature.

Patients who underwent ERCP  between  October 2020 and June 2022 at Maggiore Hospital (Bologna,Italy) were analyzed. PEP was defined according to the Cotton Consensus Criteria and graded for severity based on the revised Atlanta classification.

For each procedures  clinical, laboratory, and procedural data were collected, as well as PEP incidence and its preventive strategies (rectal NSAIDs, intravenous hydration, pancreatic stenting).  Variables were analyzed using univariate and multivariate logistic regression models.

In the period of analysis 600 ERCP were analysed. All procedures were performed by 4 experienced endoscopists. The main indications for ERCP were choledocholithiasis (50.67%), malignant stricture of the main bile duct (16.33%), and recurrent stones of the main bile duct (7%). PEP incidence was 8.8% with 0% mortality. Cannulation of the pancreatic duct and the use of precut sphincterotomy emerged as significant risk factors for PEP (Table1), with odds ratios comparable to those reported by ESGE guidelines. Injection of contrast into the pancreatic duct showed a possible association with PEP risk but was not statistically significant. Other known risk factors, such as female sex, young age, and normal bile duct diameter, were not significant in our population. Preventive measures—rectal NSAIDs and aggressive IV hydration—also showed no significant protective effect, likely because they were widely and routinely used. Pancreatic stent placement did not significantly reduce PEP incidence, possibly because the complexity of procedures at our center often necessitated frequent stent use, diminishing statistical power.

Post-ERCP pancreatitis (PEP) still represents one of the most significant complications in the biliopancreatic field. Our retrospective analysis confirmed that the incidence of this complication in our patient population is comparable to that reported in the literature (3.5–15%).Moreover, in our cohort only certain procedural factors—such as pancreatic duct cannulation and the use of precut sphincterotomy—are associated with an increased risk of PEP. Further data and multicentric studies are needed to validate our results.