title: Risk factors for post-ERCP pancreatitis: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Prevention strategies targeting risk factors could be important to reduce the rate of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis (PEP) are still debated. This systematic review and meta-analysis was performed to identify risk factors for PEP.
  
  
  METHODS
  Medline (PubMed and Ovid), Cochrane Central Register of Controlled trials & Database of Systematic Reviews, Embase, Scopus, ScienceDirect, Springer links and WEB OF SCIENCE were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Eighteen probable risk factors were evaluated, and outcomes were expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, (CI)).
  
  
  RESULTS
  When patient-related risk factors were analyzed, the ORs for female gender was 1.46 (95%CI: 1.30-1.64); for previous pancreatitis 2.03 (95%CI: 1.31-3.14); for previous PEP was 2.90 (95%CI: 1.87-4.48); for Sphincter of Oddi dysfunction (SOD) was 2.04 (95%CI: 1.73-2.33) and for Intraductal papillary mucinous neoplasm (IPMN) was 3.01 (95%CI: 1.34-6.77). Four endoscopy-related factors were confirmed: the OR for difficult cannulation was 3.49 (95%CI: 1.364-8.925); for endoscopic sphincterotomy (EST) it was 1.39 (95%CI: 1.09-1.79); for precut sphincterotomy it was 2.25 (95%CI: 1.70_2.96); and for main pancreatic duct injection it was 1.58 (95%CI: 1.21-2.08).
  
  
  CONCLUSIONS
  Female gender, previous pancreatitis, previous PEP, SOD, IPMN, difficult cannulation, EST, precut sphincterotomy and main pancreatic duct injection are risk factors for post-ERCP pancreatitis.
authors.affiliation: Postgraduate Training Base of the General Hospital of Jinan Military Command, Liaoning Medical University, Jinan, Shandong, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Gastroenterology, The General Hospital of Jinan Military Command, Jinan, Shandong, China.
authors.forename: FuCheng
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, The General Hospital of Jinan Military Command, Jinan, Shandong, China. Electronic address: yaojunwang@188.com.
authors.forename: YaoJun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D010195:Pancreatitis / Q000209:etiology*; D012307:Risk Factors
keywords: ERCP; Endoscopic retrograde cholangiopancreatography; PEP; Post-ERCP pancreatitis; Risk factor