The reported incidence of post-ERCP/
sphincterotomy pancreatitis ranges between 1.3 and 24.4% in non-selected series. This varying incidence likely reflects on the one hand difference in patient populations, indications and endoscopic expertise and, on the other hand, different definitions of
pancreatitis and methods of data collection. Among a number of patient-related factors recognized at risk for post-ERCP
pancreatitis in four recent large prospective studies, the combination of female gender, normal serum
bilirubin levels and recurrent
abdominal pain suggesting
sphincter of Oddi dysfunction and previous post-ERCP
pancreatitis placed patients at an increasingly higher risk of
pancreatitis. Among the technique-related risk factors for post-ERCP
pancreatitis, biliary sphincter balloon dilation, difficult cannulation, sphincter of Oddi manometry and pancreatic
sphincterotomy have also been recognized as significant risk factors. However, since the case mix in non-selected series does not significantly differ in the different studies, it is logical to assume that the different criteria adopted for defining the post-ERCP
pancreatitis play a key role in the reported wide variation of incidence reported for this complication. The occurrence and duration of
pain and the amplitude of serum
amylase after ERCP are critical points in the definition of post-ERCP
pancreatitis. Although a consensus conference identified 24-hour persisting
pain associated with
hyperamylasemia greater than 3 times the upper reference limit as an
indicator of
pancreatitis, these two parameters are however considered in a different manner in the studies available up to now. In a prospective study where we calculated the incidence of post-ERCP
pancreatitis by using the most widely used criteria, for both occurrence and duration of pancreatic
pain and serum
amylase amplitude, the incidence of post-procedure
pancreatitis ranged from 1.9 to 11.7% depending on the criteria adopted.