Risk Factors for Post-ERCP Cholecystitis: a Single-center Retrospective Study

Background: The risk factors for post-ERCP cholecystitis (PEC) have not been characterized. Hence, this study aimed to identify the potential risk factors for PEC.

Methods: The medical records of 4238 patients undergoing the first ERCP in a single center from January 2012 to December 2016 were analyzed in this study. A multivariate analysis was used to identify the risk factors.

Results: This study included 2672 patients who met the enrollment criteria. Of these, 36 patients (incidence rate of 1.35%) developed PEC within 2 weeks of the procedure. Univariate and multivariate analyses identified the following factors associated with PEC: history of acute pancreatitis [odds ratio (OR) = 2.60; 95% confidence interval (CI): 1.29-5.23], history of chronic cholecystitis (OR = 8.47; 95% CI: 2.54-28.24), gallbladder opacification (OR = 2.79; 95% CI: 1.37-5.70), biliary duct metallic stent placement (OR = 3.66; 95% CI: 1.78-7.54), and high leukocyte count before ERCP (OR = 1.10; 95% CI: 1.04-1.17). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.80-0.91). A prognostic nomogram was developed using the aforementioned variables to estimate the probability of PEC.

Conclusions: The risk factors, including the history of acute pancreatitis, history of chronic cholecystitis, gallbladder opacification, biliary duct metallic stent placement, and high leucocyte counts before ERCP, increased the occurrence of PEC and were positive predictors for PEC. The constructed nomogram was used to estimate the risk of PEC, guiding the implementation of prophylactic measures to prevent PEC in clinical practice.