S254 Post-Endoscopic Retrograde Cholangiopancreatography Cholangitis: A Comprehensive Systematic Review and Meta-Analysis of Incidence and Predictive Risk Factors

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been used for both diagnostic and therapeutic purposes since its introduction in 1968. However, as endoscopic ultrasound applications expand and magnetic resonance imaging technology improves, the indications for using ERCP have shifted towards therapeutic purposes. Coinciding with this change, there has been an increase in ERCP-related adverse events, most notably post-ERCP cholangitis (PEC). Updated data on PEC following a shift in ERCP use patterns is currently lacking. We aim to comprehensively examine the incidence and risk factors associated with post-ERCP cholangitis in the modern era. Methods: Relevant publications from 2000 to 2024 were obtained from Embase, MEDLINE, and PubMed. Inclusion criteria were adult patients undergoing ERCP with documentation of post-ERCP cholangitis as well as any risk factors for post ERCP cholangitis. Post ERCP cholangitis definitions were exclusively defined by each study. Exclusion criteria included studies with patient population who had risk factors for incomplete biliary drainage (malignant hilar obstructions), primary sclerosing cholangitis, and post-liver transplant on immunosuppression. Data analysis was performed using R Software. Results: Our search identified 6,701 unique citations. Thirty-eight studies were included in the final review. The average incidence of post-ERCP cholangitis was 8.08%, ranging from 0.60% to 71.90%. The median age of all patients in the studies was 61.46. Those with age >60 were more likely to develop post-ERCP cholangitis (2.02 [1.36-3.06]), while men were found to have a lower risk (0.68 [0.50-0.92]) compared to women. Though based on limited studies, balloon dilation and difficult cannulation were additionally associated with increased risk of cholangitis (7.13 [4.66-10.92]), and (5.30 [1.17-24.07]), respectively. Biliary sphincterotomy and periampullary diverticulum were not found to have an increased risk, although there was significant heterogeneity between studies. Conclusion: Our comprehensive review of studies over 24 years found an average incidence of PEC to be 8.08% with advancing age being a significant risk factor for PEC in 3.4% of patients over 60 years old. These findings highlight the importance of patient-specific risk stratification and reinforces the need for prophylactic strategies in high-risk populations to reduce the burden of PEC in the modern landscape of ERCP.