Does Obesity Increase the Incidence and Severity of Post-ERCP Pancreatitis?

Abstract

Background: Pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent studies suggest that obesity may serve as a prognostic indicator of poor outcome in non-ERCP-induced acute pancreatitis. However, to our knowledge, no one has investigated the potential association of obesity and ERCP-induced pancreatitis. The purpose of our study was to determine whether obesity conferred an increased risk and/or more severe course of post-ERCP pancreatitis. Methods: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study evaluating whether prophylactic corticosteroids reduces the incidence of post-ERCP pancreatitis. Data were collected prior to the ERCP, at the time of procedure, and 24-72 hours after discharge. Standardized criteria were used to diagnose and grade the severity of post-procedure pancreatitis. A body mass index (BMI) >30 kg/m2 was defined as obese and used as a cut-off point in this study. Results: 964 patients were enrolled in the study. Pancreatitis occurred in 149 patients (15.5%) and was graded as mild in 101 (67.8%), moderate in 42 (28.2%), and severe in 6 (4.0%). The patients were categorized by BMI using the following breakdowns: BMI <20, 20 - <25, 25 - <30, and >30, as well as BMI <30 or >30. The groups were similar with respect to patient and procedure risk factors for post-ERCP pancreatitis except the group with BMI >30 had a higher frequency of females, were younger, had less chronic pancreatitis, a lower number of pancreatic duct injections, and fewer patients receiving more than 2 pancreatic duct injections. Of the patients with a BMI <30, 119 (16.4%) developed post-ERCP pancreatitis compared to 30 (12.5%) of those with a BMI >30 (p = 0.14). There was no association between the presence of obesity and the severity of pancreatitis (p = 0.74). Patients with a BMI <20, 20 - <25, 25 - <30, and >30 had a similar incidence of post-ERCP pancreatitis. Conclusions: Obesity did not confer an increased risk for ERCP-induced pancreatitis. There was no statistically significant association between obesity and the severity of ERCP-induced pancreatitis.