Risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in the Chinese population: a systematic review and meta-analysis

Aim: To systematically identify and evaluate key risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in the Chinese population, providing evidence-based guidance to inform clinical practice, particularly strategies for prevention. Methods: A comprehensive literature search was conducted across PubMed, China National Knowledge Infrastructure, and other databases from October 2003 to October 2023. Data from 38 rigorously appraised investigations - comprising randomized controlled trials, case-control analyses, and cohort studies - were synthesized in RevMan 5.3 using both fixed- and random-effects models as appropriate. Risk factors were evaluated using odds ratios (ORs) with 95% confidence intervals (CIs), adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The meta-analysis identified 22 significant risk factors. The strongest predictors included prior post-ERCP pancreatitis (OR = 6.56, 95%CI: 2.40-17.92), duodenal papillary abnormalities (OR = 3.38, 95%CI: 1.41-8.08), and difficult cannulation (OR = 3.39, 95%CI: 2.07-5.54). Other notable factors were endoscopic papillary balloon dilation (OR = 2.75, 95%CI: 1.61-4.72), elevated superoxide dismutase (SOD) levels (OR = 2.81, 95%CI: 1.24-6.34), female gender (OR = 2.77, 95%CI: 2.00-3.82), and prolonged cannulation time (OR = 2.05, 95%CI: 1.18-3.57). In contrast, hypertension (OR = 1.93, 95%CI: 0.78-4.78) and biliary stenting (OR = 1.65, 95%CI: 0.41-6.58) were not significantly associated with ERCP. Conclusion: Procedural, anatomical, and biochemical factors were significantly associated with increased post-ERCP pancreatitis risk in Chinese patients. Early identification of high-risk individuals, especially those with prior pancreatitis or papillary abnormalities, and tailored interventions are critical for reducing incidence. These findings provide an evidence-based framework to enhance clinical outcomes in ERCP procedures.