Usefulness of pancreatic volume quantitative analysis as a predictor of development and severity in post-endoscopic retrograde cholangiopancreatography pancreatitis

Background Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious adverse events associated with ERCP. Thus, we aimed to investigate the usefulness of pre-ERCP pancreatic volume, which is deeply involved in exocrine pancreatic function, as a predictor of PEP development and severity. Methods In total, 1107 patients who underwent their first ERCP were recruited from January 2012 to December 2022 for this retrospective study. Pancreatic volume was measured by cross-sectional analysis using pre-ERCP computed tomography images. The potential risk factors for PEP were analyzed using multivariate logistic regression. Results Of the 745 patients included in the study, 34 (4.6%) developed PEP: severe, moderate, or mild PEP in 1, 7, and 26 cases, respectively. Multivariate analysis revealed that only a large pancreatic volume (> 70 cm3) was an independent risk factor for the development of PEP (odds ratio, 7.98; 95% confidence interval, 11.80-67.50; P<0.001). Additionally, the incidence of PEP was significantly higher in patients with a pancreatic volume > 70 cm3 than in those with a pancreatic volume < 70 cm3 (18.5% [31/168] vs. 0.5% [3/577]; P<0.001). Also, the association between the pre-ERCP pancreatic volume and PEP severity was positively correlated (r=0.625, P<0.005), with a larger pancreatic volume corresponding to increased PEP severity. Conclusions A large pancreatic volume before ERCP may be a novel risk factor for PEP incidence and severity. This finding suggests that quantitative analysis of the pre-ERCP pancreatic volume could be a useful predictor of PEP.