Post-ERCP Pancreatitis Incidence
Post-ERCP pancreatitis occurs in approximately 3.5-7.2% of all ERCP procedures, with the rate varying based on whether the procedure is diagnostic or therapeutic. 1, 2
Overall Incidence Rates
The most commonly cited range for post-ERCP pancreatitis is 3.5-7.2%, with the American College of Radiology reporting approximately 3.5-3.7% and prospective studies showing rates up to 7.2%. 1, 2
Diagnostic ERCP carries a lower risk (0.4-1.5%) compared to therapeutic ERCP (1.6-5.4%), though one large prospective study found similar rates between diagnostic and therapeutic procedures. 3, 2
The overall complication rate for ERCP ranges from 1.8% to 18.4%, with pancreatitis being the most common serious complication. 4
Severity Distribution
The vast majority (93%) of post-ERCP pancreatitis cases are mild and self-limiting, requiring only conservative treatment with IV fluids, pain management, and bowel rest. 2, 1
When severity is stratified: approximately 70 cases are mild, 55 moderate, and 6 severe per 1000 procedures (based on a 6.7% overall pancreatitis rate). 5
High-Risk Populations
Patients with sphincter of Oddi dysfunction have a 21.7% risk of post-ERCP pancreatitis, representing one of the highest-risk groups. 2
Those with previous ERCP-related pancreatitis face a 19-20% risk of recurrence. 2, 6
Patients with recurrent pancreatitis have a 16.2% risk, and those with intraductal papillary mucinous neoplasm (IPMN) have a 3-fold increased risk. 2, 6
Even with prophylactic pancreatic duct stenting in high-risk patients, post-ERCP pancreatitis still occurs in approximately 9.9% of cases, though severity is reduced. 7
Procedure-Specific Risk Variations
Endoscopic papillary balloon dilation (EPBD) without sphincterotomy carries a higher pancreatitis risk compared to sphincterotomy alone, though prolonged balloon dilation (>1 minute) reduces this risk to levels similar to sphincterotomy. 8
Minor papilla interventions carry a 10-15% risk of post-ERCP pancreatitis, which is substantially higher than standard ERCP. 8
Procedures involving precut sphincterotomy increase risk 2.25-fold, and difficult cannulation increases risk 3.49-fold. 6
Critical Context
The wide range in reported rates (1.8-18.4% overall complications) reflects differences in patient populations, procedural complexity, and institutional experience. 4
Female gender increases pancreatitis risk 1.46-2.6 fold, and guidewire manipulation in the pancreatic duct increases risk 8.2-fold. 4, 6
Procedure-related mortality from all ERCP complications is approximately 0.4%. 4