Abstract:Background and Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication and is associated with prolonged hospitalization and increased healthcare burden. Although several risk factors have been identified, a simple and clinically applicable prediction tool based on routine variables remains lacking. This study aimed to identify risk factors for PEP and to develop a practical prediction model.Methods A retrospective analysis was conducted on 537 patients who underwent ERCP between January 2020 and June 2025. Patients were divided into PEP and non-PEP groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram was constructed and evaluated using receiver operating characteristic (ROC) and calibration curves.Results PEP occurred in 93 patients (17.3%). Multivariate analysis identified a history of hypertension (OR=2.014), pancreatic duct opacification (OR=4.663), endoscopic papillary balloon dilation (OR=2.459), and cannulation time >57 min (OR=3.530) as independent risk factors (all P<0.05). The nomogram demonstrated good discrimination (AUC=0.750) and calibration (Hosmer-Lemeshow test, P=0.793). Among patients undergoing endoscopic papillary balloon dilation, there was no significant difference in the incidence of PEP between those with and without pancreatic duct stent placement (P>0.05).Conclusion A history of hypertension, pancreatic duct opacification, endoscopic papillary balloon dilation, and prolonged cannulation time are closely associated with the occurrence of PEP. The proposed nomogram provides a simple and effective tool for individualized risk prediction and may assist in optimizing preventive strategies for ERCP patients.