Yanyan Liu, Jiaqing Yu, Qi Zhang, Wenlu Zong, Wenxun Shao, Yuning Chu, Xiaohan Tang, Xiaoyu Li
Computed tomography-defined fatty pancreas was associated with post-ERCP pancreatitis, and the interaction analyses suggest that the association between manipulation burden and post-ERCP pancreatitis may differ according to fatty pancreas status. Larger prospective studies are needed to validate these findings.
BACKGROUND: Fatty pancreas has been associated with pancreatitis after ERCP, but its interaction with procedure-related pancreatic injury is unknown.
AIMS: We evaluated whether fatty pancreas modified the association between cumulative pancreatic manipulation and postprocedural pancreatitis.
METHODS: This multicenter retrospective cohort included 679 patients with native papillae undergoing biliary endoscopic retrograde cholangiopancreatography. Fatty pancreas was defined as a pancreas-to-spleen attenuation ratio < 0.7 on preprocedural noncontrast computed tomography. A pancreatic manipulation burden score (range, 0 - 4) assigned one point each for difficult biliary cannulation, double-guidewire technique, pancreatic duct opacification, and transpancreatic sphincterotomy. Multivariable regression assessed main effects and interaction; marginal standardization estimated adjusted risks.
RESULTS: Fatty pancreas was present in 183 patients (27.0%), and 67 (9.9%) developed pancreatitis. Fatty pancreas (adjusted odds ratio, 2.17; 95% confidence interval, 1.27 - 3.73) and each one-point score increase (adjusted odds ratio, 1.53; 95% confidence interval, 1.26 - 1.86) were associated with pancreatitis. In the continuous interaction model, the adjusted per-point score odds ratio was 1.28 (95% confidence interval, 0.98 - 1.68) without fatty pancreas and 2.08 (95% confidence interval, 1.52 - 2.84) with fatty pancreas (interaction odds ratio, 1.62; 95% confidence interval, 1.07 - 2.46; P = 0.023). The categorical analysis yielded directionally concordant interaction estimates but was not statistically significant (P = 0.067). Sensitivity analyses were directionally consistent.
CONCLUSIONS: Computed tomography-defined fatty pancreas was associated with post-ERCP pancreatitis, and the interaction analyses suggest that the association between manipulation burden and post-ERCP pancreatitis may differ according to fatty pancreas status. Larger prospective studies are needed to validate these findings.