Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis

Background: The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Statin consumption seems to lower the incidence of acute pancreatitis. We aimed to investigate the relationship between the use of statins and the incidence of PEP.

Methods: multicenter (4 Spanish tertiary-level public hospitals) retrospective cohort study. Adult patients undergoing an ERCP were included in the study. We excluded patients with chronic pancreatitis, with ongoing acute pancreatitis and those who developed other complications after ERCP. Patients were classified into 2 groups: those under statin treatment (group S) and controls (group C). A multivariate analysis was performed (binary logistic regression) including age, center, female gender, previous pancreatitis, suspected sphincter of Oddi dysfunction, difficult cannulation (>10 min), >1 pancreatic guidewire passages, pancreatic injection, pancreatic stenting and presence of choledocholitiasis.

Results: seven hundred and two patients were included, median age 74 (62-82 years), 330 (47%) females, 223 (32%) in group S. Thirty-five (5%) patients developed PEP, 6 (3%) in group S and 29 (6%) in group C. Statin use was not associated with a lower frequency of PEP in univariate analysis, OR 0.429 (95% confidence interval 0.176-1.05, p = 0.06) or in multivariate analysis, adjusted OR 0.5 (0.19-1.32), p = 0.16. Statin use had no effect on severity of PEP, being mild in 50% vs 78.6% in non-statin users, p = 0.306.

Conclusions: the chronic use of statins was not associated with a decreased risk of PEP or a milder course of disease in our sample of patients.

Keywords: Acute pancreatitis; ERCP; Hydroxymethylglutaryl-CoA reductase inhibitors; Prevention; Prophylaxis.