Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Impact of body mass index on the outcomes of endoscopic retrograde cholangiopancreatography: a systematic review and network meta-analysis

  • Erfan Arabpour (Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences) ;
  • Sina Khoshdel (Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences) ;
  • Mehdi Azizmohammad Looha (Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences) ;
  • Amir Sadeghi (Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences) ;
  • Mohammad Abdehagh (Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences)
  • Received : 2025.07.31
  • Accepted : 2025.10.14
  • Published : 2026.05.30
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Abstract

Background/Aims: Obesity is an increasing health concern worldwide, and an elevated body mass index (BMI) may influence the outcomes of endoscopic retrograde cholangiopancreatography (ERCP). This systematic review and network meta-analysis aimed to investigate the association between BMI and ERCP outcomes. Methods: A systematic search was performed using PubMed, Scopus, and Web of Science to identify relevant studies that reported clinical outcomes of ERCP in different BMI groups. Patients were categorized into five BMI-based following groups: underweight (BMI<18.5 kg/m2), normal weight (18.5 kg/m2≤BMI<25 kg/m2), overweight (25 kg/m2≤BMI<30 kg/m2), obesity (30 kg/m2≤BMI<40 kg/m2), and morbid obesity (40 kg/m2≤BMI). Results: Among 3,001 unique citations, seven were included in the study. Meta-analysis revealed that obesity was not associated with an increased risk of post-ERCP pancreatitis (PEP) (odds ratio, 1.33; 95% confidence interval, 0.62-2.87). In the network analysis, none of the five BMI groups had a significantly higher risk of PEP than that of the other groups (p>0.05). Moreover, the BMI groups had similar rates of difficult cannulation, successful cannulation, complete stone extraction, and procedural success. Conclusions: ERCP success and adverse events were similar among different BMI groups. Neither an elevated nor a low BMI was associated with an increased risk of PEP. Further large-scale prospective studies are required to validate these findings.

Keywords

References

  1. World Health Organization (WHO). Obesity and overweight. WHO; 2024.
  2. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88. https://doi.org/10.1186/1471-2458-9-88
  3. Sundararaman L, Goudra B. Sedation for GI endoscopy in the morbidly obese: challenges and possible solutions. J Clin Med 2024;13:4635. https://doi.org/10.3390/jcm13164635
  4. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2020;52:127–149. https://doi.org/10.1055/a-1075-4080
  5. Jirapinyo P, Thompson CC. Sedation challenges: obesity and sleep apnea. Gastrointest Endosc Clin N Am 2016;26:527–537. https://doi.org/10.1016/j.giec.2016.03.001
  6. Gordon V, Chowdhury A, Keim S. Etiology and comorbidity diagnoses effect on outcomes for patients undergoing endoscopic retrograde cholangiopancreatography. Cureus 2020;12:e10209. https://doi.org/10.7759/cureus.10209
  7. Higgins JP, Jackson D, Barrett JK, et al. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012;3:98–110. https://doi.org/10.1002/jrsm.v3.2
  8. Fujisawa T, Kagawa K, Hisatomi K, et al. Obesity with abundant subcutaneous adipose tissue increases the risk of post-ERCP pancreatitis. J Gastroenterol 2016;51:931–938. https://doi.org/10.1007/s00535-016-1160-x
  9. Ihimoyan A, Vootla V, Lale A, et al. ERCP in obese patients: a retrospective analysis of efficacy and safety. Am J Gastroenterol 2011;106:S70–S71. https://doi.org/10.14309/00000434-201110002-00179
  10. Zivari K, Gonuguntla VT, Yunina D, et al. Impact of patient's weight on performing endoscopic retrograde cholangiopancreatography (ERCP) and its complications?: a retrospective, single-center study. Gastroenterology 2019;156:S1046. https://doi.org/10.1016/S0016-5085(19)39571-X
  11. Chen B, Yo CH, Patel R, et al. Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: a national cohort study. United European Gastroenterol J 2021;9:561–570. https://doi.org/10.1002/ueg2.v9.5
  12. Deenadayalu VP, Blaut U, Watkins JL, et al. Does obesity confer an increased risk and/or more severe course of post-ERCP pancreatitis?: a retrospective, multicenter study. J Clin Gastroenterol 2008;42:1103–1109. https://doi.org/10.1097/MCG.0b013e318159cbd1
  13. Abdelfatah MM, Koutlas NJ, Gochanour E, et al. Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol 2019;32:298–302. https://doi.org/10.20524/aog.2019.0367
  14. Jaruvongvanich V, Garimella V, Kaur J, et al. Obesity and risk for incomplete stone clearance in patients with bile duct stones undergoing ERCP. Obes Surg 2024;34:690–693. https://doi.org/10.1007/s11695-023-06983-8
  15. Devani K, Charilaou P, John F, et al. Impact of morbid obesity in hospitalized patients undergoing endoscopic retrograde cholangiopancreatography: 5-year snapshot from national inpatient sample 2007-2011: 2016 ACG presidential poster award. Am J Gastroenterol 2016;111:S421. https://doi.org/10.14309/00000434-201610001-00968
  16. Hong S, Qiwen B, Ying J, et al. Body mass index and the risk and prognosis of acute pancreatitis: a meta-analysis. Eur J Gastroenterol Hepatol 2011;23:1136–1143. https://doi.org/10.1097/MEG.0b013e32834b0e0e
  17. Krishna SG, Hinton A, Oza V, et al. Morbid obesity is associated with adverse clinical outcomes in acute pancreatitis: a propensity-matched study. Am J Gastroenterol 2015;110:1608–1619. https://doi.org/10.1038/ajg.2015.343
  18. Bai Y, Gong G, Aierken R, et al. A retrospective study investigating the clinical significance of body mass index in acute pancreatitis. PeerJ 2024;12:e16854. https://doi.org/10.7717/peerj.16854
  19. Chandrasekar B, Boylston WH, Venkatachalam K, et al. Adiponectin blocks interleukin-18-mediated endothelial cell death via APPL1-dependent AMP-activated protein kinase (AMPK) activation and IKK/ NF-kappaB/PTEN suppression. J Biol Chem 2008;283:24889–24898. https://doi.org/10.1074/jbc.M804236200
  20. Folco EJ, Rocha VZ, López-Ilasaca M, et al. Adiponectin inhibits pro-inflammatory signaling in human macrophages independent of interleukin-10. J Biol Chem 2009;284:25569–25575. https://doi.org/10.1074/jbc.M109.019786
  21. Wade TE, Mathur A, Lu D, et al. Adiponectin receptor-1 expression is decreased in the pancreas of obese mice. J Surg Res 2009;154:78–84. https://doi.org/10.1016/j.jss.2008.05.006
  22. Akshintala VS, Boparai IS, Barakat MT, et al. Post endoscopic retrograde cholangiopancreatography pancreatitis: novel mechanisms and prevention by drugs. United European Gastroenterol J 2025;13:78–85. https://doi.org/10.1002/ueg2.v13.1
  23. Cotton PB, Garrow DA, Gallagher J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009;70:80–88. https://doi.org/10.1016/j.gie.2008.10.039
  24. Oh CH, Dong SH, Kim JW, et al. Radiation exposure during endoscopic retrograde cholangiopancreatography according to clinical determinants. Medicine (Baltimore) 2020;99:e19498. https://doi.org/10.1097/MD.0000000000019498