Coimbatore Medical College and Hospital Thiruvananthapuram, Kerala, India
Sony Thomas, MBBS, MD1, Bomy Thomas, B Tech, MBA2 1Coimbatore Medical College and Hospital, Thiruvananthapuram, Kerala, India; 2Georgia Institute of Technology, Pathanamthitta, Kerala, India Introduction: Post ERCP pancreatitis (PEP) is the most common adverse event associated with ERCP. Various patient related & procedure related factors contribute to PEP. To date there is no reliable marker to predict the severity of PEP. The objective of this study is to investigate the incidence & risk factors of PEP & to evaluate the feasibility of serum phosphate as a marker for predicting the severity of PEP Methods: We retrospectively analyzed the clinical data of 298 patients who underwent ERCP at Coimbatore medical college from January 2023 to January 2025.
Desired duct canulation was attained in 261 cases. Among 261 cases 39 patients developed PEP.
These patients were divided into study group (n=39 with PEP) & control group (n=222 without PEP) & their clinical data & intra operative conditions were compared.
Multivariate logistic regression analysis was performed to identify the independent factors associated with risk of developing PEP.
The 39 patients who developed PEP were divided into 2 groups based on severity (mild, moderate to severe)
The relation between serum phosphate measured 12 hours post ERCP & severity of PEP was evaluated.
The optimal cut off value of serum phosphate for predicting severity of pancreatitis was identified. Results: Out of 261 cases there were 136 females
69.1% were below 60 years.
The most common indication for ERCP was choledocholithiasis (78.4%)
14.9 % developed PEP.
Multivariate logistic regression analysis showed that age below 60 years, female sex, history of pancreatitis, multiple canulation attempts ( >3), prolonged canulation duration ( >5 minutes), pancreatic duct canulation & sphincteroplasty were independent risk factors for PEP
Out of 39 patients with PEP 53.3% had mild pancreatitis
Correlation coefficient measurement showed a positive correlation between serum phosphate & severity of PEP
Subgroup analysis revealed that phosphate values above 4.7 is predictive of moderately severe pancreatitis & phosphate above 5.3 is predictive of severe pancreatitis.
Study also demonstrated that serum phosphate was more accurate than BISAP score for predicting the severity of PEP Discussion: Clinicians need to evaluate these independent risk factors before ERCP to effectively prevent PEP.
Serum phosphate is closely associated with severity of PEP. If validated it can be used as a valuable prognostic marker. Early prediction of severe PEP with serum phosphate leads to more effective care of patients with PEP
Figure: Baseline characteristics of patients & results of multivariate logistic regression analysis
Figure: Correlation of serum phosphate with PEP severity & correlation of phosphate with BISAP score
Disclosures: Sony Thomas indicated no relevant financial relationships. Bomy Thomas indicated no relevant financial relationships.
Sony Thomas, MBBS, MD1, Bomy Thomas, B Tech, MBA2. P4336 - Analysis of Risk Factors Leading to Post ERCP Pancreatitis (PEP) and Relevance of Serum Phosphate for Predicting the Severity of PEP, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
