Is fatty liver associated with post-ERCP pancreatitis?

Background: Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several factors have been already found associated with post ERCP pancreatitis (PEP), although there is still controversy in some areas. Aim: We aim to identify possible risk factors associated with PEP in a referral tertiary center. Method and Material: All patients undergoing ERCP from 2013 to 2016 in our university hospital were enrolled and their data including demographic, clinical, paraclinical and endoscopic information were reviewed. Patients meeting the criteria for PEP were identified and the severity of PEP was determined. Data from patients diagnosed with PEP was compared to the rest. Technical/operator variables were unchanged during our study period of 3 years. Incomplete patients’ files were omitted. We had no exclusion criteria. Results: Of the 462 patients (200 women, 262 men; mean age of 59 with age range: 21-92), PEP developed in 24 patients (5.2%) among who, 19 cases were mild, 4 were moderate and one was severe. Significant variables (both patient- and endoscopic-related) found associated with PEP were fatty liver (P=.04), difficult cannulation (p=0.001) and balloon dilatation (p=0.001). PEP was not associated with age or gender, history of smoking or alcohol use, and comorbidities (including diabetes mellitus, hypertension, ischemic heart disease, cancer, cirrhosis, inflammatory bowel disease). Regarding the laboratory data, liver enzymes were significantly higher in PEP patients and creatinine level was significantly lower in this group. However, hemoglobin and bilirubin, erythrocyte sedimentation rate (ESR), lipid profile, platelet and WBC count and amylase level before ERCP showed no significant relation with PEP. Using statin was associated with decreased PEP frequency. Among endoscopic-related factor, precut, brush cytology and sphinctrotomy were not related with PEP. Of the total ERCPs, 62% were successful, 25.5% were partially successful and 9.5% failed. According to pathology results, the etiology was CBD stone in 75%, malignancy in 24% and undetermined in the remaining 1%. Neither ERCP result nor final pathologic diagnosis were associated with PEP. Conclusion: Patients with fatty liver might be at higher risk for developing PEP. On the other hand, statins might play a role in reducing the incidence of PEP.