Impact of pancreatic steatosis on risk of Post-ERCP pancreatitis: Systematic review and meta-analysis

Abstract

Background Pancreatic steatosis (PS) is characterized by fat accumulation within the pancreas. Although several risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been identified, the role of pancreatic steatosis (PS) remains inadequately explored. Methods We conducted a systematic review and meta-analysis to evaluate the association between PS and PEP. Multiple databases were searched through June 2025. Studies comparing PEP incidence with and without PS were included. The primary outcome was the incidence of PEP, and the secondary outcome was PEP severity. A random-effects model was utilized, and effect estimates were expressed as odds ratios (OR) and 95 % confidence interval (CI). Heterogeneity was assessed using the I2 statistic. Results Five eligible studies with 2197 patients (mean age 69.7 years, 51.1 % female) were included. Patients with PS had significantly higher odds of PEP (OR 3.67; 95 % CI 2.29–5.90; I2 = 26 %). On subgroup analysis, PS was consistently associated with significantly higher PEP odds. This included studies in East Asia (OR 2.79; 95 % CI 1.77–4.40; I2 = 0 %) and Europe (OR 6.68; 95 % CI 3.10–14.43; I2 = 0 %), retrospective studies (OR 4.44; 95 % CI 2.67–7.36; I2 = 0 %), and studies not utilizing rectal non-steroidal anti-inflammatory drugs (OR 2.79; 95 % CI 1.77–4.40; I2 = 0 %). There was a non-significant trend toward increased odds of severe PEP with PS (OR 2.17, 95 % CI 0.65–7.25; I2 = 0 %) Conclusions PS appears to be a significant risk factor for the PEP and may help improve risk stratification before ERCP. Nevertheless, further large-scale prospective studies are needed to validate our results.