Visceral Adipose Tissue as an Independent Predictor of Severe Post‐ERCP Pancreatitis: A Multicenter Retrospective Cohort Study

BACKGROUND: Acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), known as post-ERCP pancreatitis (PEP), is a major adverse event. Although risk factors for PEP incidence have been widely studied, factors associated with severe PEP remain unclear. AIM: To identify risk factors, including body composition, associated with severe PEP. METHODS: A retrospective cohort study was conducted in patients who underwent ERCP at two tertiary care centers in Japan between January 2013 and October 2021. PEP severity was defined according to the American Society of Gastrointestinal Endoscopy Workshop criteria (2010). Patients were divided into mild and moderate-to-severe groups. Body composition parameters, including skeletal muscle index, subcutaneous adipose tissue, and visceral adipose tissue (VAT), were assessed using CT. Multivariate analysis was performed to identify factors associated with severe PEP. RESULTS: was the only independent risk factor for severe PEP (OR 2.79, p = 0.04). CONCLUSION: VAT may be associated with severe PEP. ERCP should be performed with awareness of the increased risk of severe PEP in patients with high visceral adiposity.