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News

Risk factors for complications of ERCP in primary sclerosing cholangitis

The most recent issue of Endoscopy identifies risk factors for complications of ERCP in primary sclerosing cholangitis.

News image

Endoscopic retrograde cholangiographic pancreatography (ERCP) is the most accurate technique for surveillance of patients with primary sclerosing cholangitis.

Dr Ismail and colleagues evaluated risk factors for complications of ERCP in patients with primary sclerosing cholangitis.

In 2007 - 2009 we performed 441 ERCPs in patients with primary sclerosing cholangitis.

The primary tools for ERCP were a guide wire and papillotomy knife to gain access into the biliary duct.

If the primary cannulation failed, and the wire went only into the pancreatic duct, pancreatic sphincterotomy was performed.

If necessary, a further oblique cut with a needle knife was done in order to expose the biliary duct.

Post-ERCP pancreatitis was diagnosed in 7%
Endoscopy

The research team found that primary cannulation was successful in 88% of patients.

Of these, 38% of patients had had biliary sphincterotomy performed previously.

In the group with failed primary cannulation, access into the biliary duct was achieved after pancreatic sphincterotomy in 52 patients.

In 11 of these, the team found that a further cut with a needle knife was performed.

The researchers observed that post-ERCP pancreatitis (PEP) was diagnosed in 7%.

Factors predicting PEP were female sex, and a guide wire in the pancreatic duct.

The team noted that previous biliary sphincterotomy was a protective factor.

The risk of PEP increased with the number of times the wire accidentally passed into the pancreatic duct.

The team found that cholangitis developed in 1%.

Dr Ismail's team concluded, "In patients with primary sclerosing cholangitis the incidence of ERCP complications remained relatively low."

"The complication risk increased with the complexity of cannulation."

"In a patient with primary sclerosing cholangitis in whom follow-up ERCP is planned, biliary sphincterotomy should be considered, as it may protect against PEP."

Endoscopy 2012: DOI: 10.1055/s-0032-1325677
21 November 2012

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