Analyses of endoscopic retrograde cholangiopancreatography (ERCP) complication are often constrained by the number of endpoints observed.
Dr Williams and colleagues from the United Kingdom identified the principal risk factors for ERCP complication.
|Risk factors for pancreatitis was ERCP performance in a district hospital|
The team conducted a prospective multicenter study of ERCP complications, based in 5 English regions.
An exploratory univariable analysis of patients' first recorded procedures identified potentially important patient- and procedure-related factors.
For overall complications and pancreatitis, variables significant in univariable analysis were included in multiple regression.
The researchers collected data of 66 centers on 5,264 ERCPs, performed on 4561 patients.
A therapeutic intervention was attempted in 76 % of patients as part of their first recorded ERCP.
Following first recorded ERCP, 5% of patients suffered 1 complication.
About 2% of patients had pancreatitis, 1% had cholangitis, 1% had hemorrhage, less than 1% had perforation, and 1% had miscellaneous complications.
The team included significant factors from multiple regression in a multi-level analysis.
The regression analysis incorporated variables measured at the level of the endoscopist and hospital.
The team found for overall complication, risk factors included more than 1 cannulation attempt, precut, and suspected sphincter of Oddi dysfunction.
For pancreatitis, risk factors were more than 1 cannulation attempt, female sex, age, and performance in a district hospital.
Dr Williams' team concluded, "Careful patient selection combined with skilled cannulation minimizes complications."
"Higher-risk procedures should be performed in specialist centers."