Intrapancreatic Fat Deposition and Risk of Post-ERCP Pancreatitis: A Systematic Review and Meta-analysis.

OBJECTIVES Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of this procedure. Emerging evidence suggests that intrapancreatic fat deposition (IPFD) may influence susceptibility to PEP, and its impact on clinical severity remains unclear. This meta-analysis aimed to evaluate whether IPFD is associated with an increased risk and severity of PEP.

METHODS We systematically searched PubMed, Embase, and Cochrane Central databases to identify studies that compared patients who underwent ERCP with and without radiologically defined IPFD to investigate the incidence of PEP. Adjusted pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to reduce confounding factors. Heterogeneity was assessed using the I2 statistic.

RESULTS Three studies involving 1,950 patients were included. A significantly higher incidence of PEP was observed in patients with IPFD than in those without IPFD (OR: 3.07; 95% CI: 2.00-4.73; P<0.001; I²=4%). In the multivariable analysis, this association remained statistically significant, indicating that IPFD was an independent risk factor for PEP (OR: 2.50; 95% CI: 1.57-3.96; P<0.001; I²=19.1%). Importantly, IPFD was also associated with an increased risk of severe PEP (OR: 5.01; 95% CI: 1.47-17.04; P=0.010; I²=0%).

CONCLUSION IPFD was a significant contributor to the overall risk of PEP and its severe form. These findings highlight pancreatic fat as a potentially modifiable preprocedural risk factor, indicating the need for further validation and consideration of targeted prophylactic strategies to prevent post-ERCP pancreatitis.