Risk factors for post-ERCP pancreatitis: a systematic review and meta-analysis of observational studies

Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication following ERCP. This study primarily aims to analyze the risk factors contributing to PEP development, thereby providing evidence-based guidance for clinical practice. We systematically searched the PubMed, Cochrane Library, Embase, Web of Science databases for studies on risk factors for PEP. Ultimately, 24 studies comprising a total of 58,202 patients were included. Literature screening and quality assessment adhered to the standards of the Cochrane Collaboration and Newcastle-Ottawa scales. Stata (Version 18.0) was used for meta-analysis. The Results showed that female (OR,0.74;95%CI,0.64–0.85), elderly patient (≥ 60 years old) (OR,1.75;95%CI,1.53–1.99), previous pancreatitis (OR,2.44;95%CI, 1.55–3.84), pancreatic duct imaging (OR,2.48;95%CI,2.01–3.06), difficult biliary cannulation (OR,3.27;95%CI,2.84–3.77), SOD(OR,2.60;95%CI,2.06–3.28), previous history of PEP(OR,2.75;95%CI,1.10–6.88) and pancreatic stent (OR,1.83;95% CI,1.27–2.64) were independent risk factors for PEP. This meta-analysis identified several factors associated with an increased risk of PEP (female sex, older age, prior pancreatitis, pancreatic duct imaging, difficult cannulation, SOD, prior PEP, and pancreatic stent placement). These findings may aid risk stratification. However, due to the observational design and heterogeneity of included studies, results should be considered hypothesis-generating. Future prospective studies are needed to confirm these associations.