S258 Analysis of Risk Factors Leading to Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Relevance of Serum Phosphate for Predicting the Severity of PEP

Introduction: Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common adverse event associated with ERCP. Various patient related and 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 and risk factors of PEP and 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) and control group (n = 222 without PEP) and their clinical data and 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 and 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 women. 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 and 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 and severity of PEP. Subgroup analysis revealed that phosphate values above 4.7 is predictive of moderately severe pancreatitis and 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. Conclusion: 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.