Higher Risk of Post‐Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Patients With Asymptomatic Common Bile Duct Stones Compared to Symptomatic Cases: A Propensity Score‐Matched Cohort Analysis

ABSTRACT Background and Aims Endoscopic retrograde cholangiopancreatography (ERCP), the standard procedure for common bile duct (CBD) stones (CBDS) removal, carries a risk of post‐ERCP pancreatitis (PEP). We compared PEP‐related factors between asymptomatic and symptomatic CBDS cases. Methods A retrospective cohort study was conducted on 367 patients who underwent ERCP for CBDS. To adjust for baseline differences, propensity score matching (PSM) was performed, yielding 170 matched patients (85 asymptomatic and 85 symptomatic groups) for comparative analysis of PEP‐related factors. Results Baseline differences in the proportion of patients with American Society of Anesthesiologists‐Physical Status (≥ 3) cases, CBD diameter, and CBDS size were eliminated after PSM. The asymptomatic group had a significantly longer ERCP procedure time (20 vs. 18‐min, p = 0.02) and a higher incidence of PEP compared to the symptomatic group (11.8% vs. 1.2%, p = 0.01). Multivariate analysis confirmed that asymptomatic CBDS cases (odds ratio [OR]: 9.37, 95% confidence interval [CI]: 1.13–77.6, p = 0.0381) and prolonged procedure time (> 26 min, OR: 5.29, 95% CI: 1.26–22.3, p = 0.0231) were independent risk factors for PEP. Conclusions ERCP procedures performed for asymptomatic CBDS cases are associated with a higher risk of PEP. The decision to perform ERCP in asymptomatic CBDS cases should carefully consider the PEP risk factors of the patient. Trial Registration: UMIN000055951