Nonalcoholic fatty liver disease and the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis: the hidden danger

Background: Nonalcoholic fatty liver disease (NAFLD) has been identified as risk factor for several diseases; however, its association with post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been studied. Aims: To assess whether NAFLD is a risk factor for the development of PEP. Methods: We performed a retrospective multicenter study. All patients who underwent ERCP during 2013–2016 at either the Shaare Zedek Medical Center in Jerusalem or EMMS Nazareth hospital and who had a diagnosis of NAFLD by abdominal imaging were eligible for inclusion. Four hundred and one patients were included, among them, 38 (9.5%) were diagnosed with PEP according to clinical, laboratory and radiological criteria. Results: In univariate analysis, the following risk factors were associated with increased risk for PEP; Fatty liver (OR 2.363, p =.01), elevated levels of aspartate transaminase (OR 1.008, p =.04), ALT (OR 0.979, p =.0007), alkaline phosphatase (OR 1.008, p =.01), gamma-glutamyl transferase (OR 1.014, p =.0005) and total bilirubin (OR 1.141, p =.005). In multivariate logistic regression analysis, only NAFLD showed statistically significant association with PEP (OR 3.224, 95% CI 1.548-6.713, p =.001) with receiver operator characteristics (ROC) area under the curve (AUC) of 0.8156. Conclusion: NAFLD was shown to be a risk factor for PEP. Therefore, we suggest considering prophylactic pancreatic stenting and/or NSAID’s suppositories among these patients.