120 Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Benign vs Malignant Biliary Obstruction

Abstract Background Post-ERCP pancreatitis (PEP) is one of the most common complications following ERCP. While several patient- and procedure-related risk factors have been identified, the role of underlying disease pathology (benign versus malignant biliary obstruction) is not established. Understanding this relationship may improve patient risk stratification, guide the selection of ERCP over alternative investigations, and inform prevention strategies. This study investigates whether disease aetiology influences PEP incidence. Method A retrospective study was conducted of patients ≥18 years who underwent ERCP between January 2019 and December 2024. Data was collated from demographics, underlying diagnosis (benign or malignant), development of PEP (defined by elevated serum amylase and imaging findings), and use of PEP prophylaxis. Results 600 patients were included: 422 with benign obstruction and 158 with malignant. PEP occurred in 64 patients (10.7%). Of those with benign aetiology (n = 442), 9.7% (n=43) developed PEP compared to 13.3% (n = 21) of patients with malignant (n= 158). The difference in PEP incidence between groups was not statistically significant (p = 0.21, Chi-square test). Prophylaxis was given to 79.4% of patients with benign disease and 75.3% with malignant. Conclusions The incidence of PEP was higher in patients with malignant biliary obstruction compared to those with benign; however, this was not statistically significant. This suggests that disease pathology alone may not be an independent risk factor for PEP. Larger, prospective studies are required to validate this trend and further guide risk stratification, diagnostic decision-making, and preventative strategies.