Elsevier

Gastrointestinal Endoscopy

Volume 56, Issue 5, November 2002, Pages 652-656
Gastrointestinal Endoscopy

Original Articles
Risk factors for complications after performance of ERCP

https://doi.org/10.1016/S0016-5107(02)70112-0Get rights and content

Abstract

Background: ERCP has become widely available for the diagnosis and treatment of benign and malignant pancreaticobiliary diseases. In this prospective study, the overall complication rate and risk factors for diagnostic and therapeutic ERCP were identified. Methods: Data were collected prospectively on patient characteristics and endoscopic techniques from 1223 ERCPs performed at a single referral center and entered into a database. Univariate and multivariate analyses were used to identify risk factors for ERCP-associated complications. Results: Of 1223 ERCPs performed, 554 (45.3%) were diagnostic and 667 (54.7%) therapeutic. The overall complication rate was 11.2%. Post-ERCP pancreatitis was the most common (7.2%) and in 93% of cases was self-limiting, requiring only conservative treatment. Bleeding occurred in 10 patients (0.8%) and was related to a therapeutic procedure in all cases. Nine patients had cholangitis develop, most cases being secondary to incomplete drainage. There was one perforation (0.08%). All other complications totaled 1.5%. Variables derived from cannulation technique associated with an increased risk for post-ERCP pancreatitis were precut access papillotomy (20%), multiple cannulation attempts (14.9%), sphincterotome use to achieve cannulation (13.1%), pancreatic duct manipulation (13%), multiple pancreatic injections (12.3%), guidewire use to achieve cannulation (10.2%), and the extent of pancreatic duct opacification (10%). Patient characteristics associated with an increased risk of pancreatitis were sphincter of Oddi dysfunction (21.7%) documented by manometry, previous ERCP-related pancreatitis (19%), and recurrent pancreatitis (16.2%). Pain during the procedure was an important indicator of an increased risk of post-ERCP pancreatitis (27%). Independent risk factors for post-ERCP pancreatitis were identified as a history of recurrent pancreatitis, previous ERCP-related pancreatitis, multiple cannulation attempts, pancreatic brush cytology, and pain during the procedure. Conclusions: The most frequent ERCP-related complication was pancreatitis, which was mild in the majority of patients. The frequency of post-ERCP pancreatitis was similar for both diagnostic and therapeutic procedures. Bleeding was rare and mostly associated with sphincterotomy. Other complications such as cholangitis and perforation were rare. Specific patient- and technique-related characteristics that can increase the risk of post-ERCP complications were identified. (Gastrointest Endosc 2002;56:652-6.)

Section snippets

Patients and methods

A prospective, single-center study was conducted of postprocedure complications associated with 1223 consecutive ERCPs performed over 31 months. The study was conducted in accordance with the Helsinki Declaration. All patients signed an informed consent for the procedure. Diagnostic and therapeutic procedures in both inpatients and outpatients were included. All procedures were performed with standard duodenoscopes. In the majority of cases, procedures were started by a doctor in the fourth

Results

A total of 1223 patients (733 [60%] women, 490 [40%] men; mean age 53 years, range 17-101 years) underwent ERCP. The procedure was diagnostic in 554 (45.3%) and therapeutic in 667 (54.7%), although the majority of patients were referred for an expected therapeutic ERCP. Sphincterotomy was performed in 213 patients, bile duct stents were placed in 209, pancreatic stents in 94, and metallic stents in 73.

The overall post-ERCP complication rate was 11.2% (Table 1).

. Overall complication rates in

Discussion

Since the introduction of endoscopic sphincterotomy and the development of biliary stents, ERCP has become an essential diagnostic and therapeutic modality for the management of a variety of pancreatic and biliary diseases. Early studies of the safety of ERCP were usually retrospective.1, 3, 5, 6, 7 More recent studies have been prospective, but these have focused primarily on the complications of therapeutic ERCP.8 Herein, the results are reported of a large prospective study of the safety of

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Reprint requests: David L. Carr-Locke, MD, FRCP, Director of Endoscopy, 75 Francis St., Brigham & Women's Hospital, Boston, MA 02115.

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