Risk factors for post-ERCP pancreatitis

Definite risk factors		Likely risk factors
Patient-related	Procedure-related	Patient-related	Procedure-related
Female sex History of acute pancreatitis History of post-ERCP pancreatitis Suspected sphincter of Oddi dysfunction	Difficult cannulation of the bile duct ≥1 pancreatic guidewire passage^* Pancreatic duct contrast injection	Younger age (<55 years) Nondilated extrahepatic bile duct Absence of chronic pancreatitis Normal serum bilirubin End-stage kidney disease	Precut sphincterotomy^¶ Pancreatic sphincterotomy Biliary sphincter balloon dilation Incomplete clearance of bile duct stones Intraductal ultrasound Metallic biliary stent

* Deep pancreatic duct guidewire passage without pancreatic stent placement.

¶ In multicenter observational studies, precut sphincterotomy was a risk factor. However, in trials at specialized centers, early precut was associated with lower risk of post-ERCP pancreatitis.

Adapted from: Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52:127.

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Risk factors for post-ERCP pancreatitis