Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. A reported complication rate a! er ERCP varies between 5 % and 10 %. The aim of the present study was to investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia. Methods: Consecutive ERCP procedures were studied at three centers in Guayaquil, Ecuador from October 2013 to May 2017. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors Results: A total of 652 procedures were performed. The mean number of ERCP procedures performed at each center ranged from 2.1 to 6.0 per endoscopist per week. Overall, complications developed in 52 (7.92%) patients, pancreatitis in 28 (4.31%), and asymptomatic hyperamylasemia in 96 (14.72%). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95% confidence interval (CI): 1.14-2.02, P=0.004), periampullary diverticulum (OR: 2.02, 95% CI: 1.49-2.73, P10 min (OR: 1.51, 95% CI: 1.08-2.10, P=0.016), > or =1 pancreatic deep wire pass (OR: 1.80, 95% CI: 1.33-2.42, P10 min (OR: 1.76, 95% CI: 1.13-2.74, P=0.012), > or =1 pancreatic deep wire pass (OR: 2.77, 95% CI: 1.79-4.30, P10 min (OR: 1.96, 95% CI: 1.52-2.54, P or =1 pancreatic deep wire pass (OR: 2.24, 95% CI: 1.74-2.89, P Conclusion: In conclusion, patient-related risk factors are as important as procedure-related ones in determining the risk for overall post-ERCP complications and pancreatitis. I ese & ndings emphasize the importance in the avoidance of high-risk procedures such as unintentional pancreatic deep wire pass, prolonged cannulation time, and needle-knife precut, especially in high-risk patients such as younger women and patients with periampullary diverticulum. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related. I e diJ erence in patient-related factors between pancreatitis and asymptomatic hyperamylasemia suggests that the host susceptibility represents an important factor in the mechanism by which post-ERCP pancreatitis develops.