Incidence of Cholangitis in Post‐Endoscopic Retrograde Cholangiopancreatography ( ERCP ): A Systematic Review and Meta‐Analysis

ABSTRACT Background Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines x‐ray and upper gastrointestinal (GI) endoscopy for diagnosis and treatment of pancreatic and biliary diseases. Cholangitis is the main infectious complication after ERCP surgery. Current evidence synthesis remains limited by the absence of cholangitis‐specific incidence quantification in prior meta‐analyses, which predominantly report composite infection metrics. This important evidence gap impedes accurate risk assessment for this procedure‐dominant complication. To address this deficit, we conducted a systematic review and meta‐analysis to determine the isolated incidence of post‐ERCP cholangitis. Methods We conducted a systematic review and a meta‐analysis of the incidence of cholangitis in Post‐ERCP for studies that were published in both PubMed and EMBASE up to February 6th, 2023. Overall and subgroup pooled effect estimates (continents, age, and publication year) with 95% confidence interval were evaluated by using inverse‐variance pooling and logit‐transformed proportions model. Risk of bias assessment was accessed by using ROBINS‐I guidelines. Results Our search initially retrieved 1622 unique studies, of which 97 studies met the inclusion criteria. Overall pooled rate was 1.70% (95% CI: 1.41%–2.04%). The subgroup continent pooled rate for South America, North America, Europe, Asia, and Africa were 1.04% (95% CI: 0.22%–4.89%, n = 2 studies), 1.21% (95% CI: 0.75%–1.93%, n = 17 studies), 1.79% (95% CI: 1.36%–2.35%, n = 34 studies), 1.86% (95% CI: 1.41%–2.45%, n = 41 studies), 2.35% (95% CI: 0.01%–83.49%, n = 3 studies), respectively. Conclusion We provide robust point effect estimates of post‐ERCP cholangitis. Given the mortality and morbidity burden associated with ERCP‐related infectious outbreaks, this finding can inform public health policy regarding the health effects of hospital‐related infection on taking appropriate measures, especially in vulnerable populations.