Timing of endoscopic retrograde cholangiopancreatography and its association with procedure-related complications: a retrospective observational study

The optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) remains controversial, particularly outside the context of acute cholangitis. While early intervention is recommended in certain guidelines, high-quality evidence supporting specific timeframes is limited. This study aimed to evaluate whether the timing of ERCP affects the rate of post-procedural complications and length of hospital stay in a broad patient population. This retrospective observational study included 406 patients who underwent ERCP between January 2021 and December 2023. Patients were categorized into three groups based on the timing of ERCP after hospital admission: <24 h, 24–72 h, and > 72 h. Demographic and laboratory parameters, procedural indications, complication rates (including post-ERCP pancreatitis), and hospital stay were compared among groups. A total of 406 patients were included, of whom 102 (25%) underwent ERCP within 24 h, 137 (33.6%) between 24 and 72 h, and 167 (41.4%) after 72 h. Total bilirubin levels were significantly higher in patients who underwent ERCP after 72 h, while length of hospital stay was shortest in the < 24 h group and longest in the > 72 h group ( p < 0.001). Indications differed between groups, with cholangitis more frequent in < 24 h procedures, malignant stricture more common in > 72 h, and acute pancreatitis more frequently the indication in delayed procedures. The overall rate of post-ERCP complications was lowest in the 24–72 h group (4.4%) compared with both < 24 h (12%) and > 72 h (12%) groups ( p = 0.038). Multivariate logistic regression identified ERCP timing as the only independent predictor of complications, with both urgent (< 24 h) and delayed (> 72 h) interventions associated with a significantly higher risk compared with the 24–72 h group. ERCP performed between 24 and 72 h after hospital admission is associated with lower complication rates and shorter hospital stays, suggesting that this timeframe may offer an optimal balance between safety and efficacy. These findings may inform future prospective studies and procedural timing recommendations for ERCP in diverse patient populations.