ERCP has become widely available for the diagnosis, and treatment of benign and malignant pancreaticobiliary diseases.
In this prospective study, published in Gastrointestinal Endoscopy, the research team identified the overall complication rate and risk factors for diagnostic and therapeutic ERCP.
The team collected data on patient characteristics and endoscopic techniques from 1223 ERCPs performed at a single referral center.
Univariate and multivariate analyses were used to identify risk factors for ERCP-associated complications.
Of 1223 ERCPs performed, 45% were diagnostic and 55% therapeutic.
|ERCP complication rate = 11%.|
The research team found the overall complication rate to be 11%.
They identified the most common complication as post-ERCP pancreatitis (7%), this was self-limiting in 93% of cases and required conservative treatment.
Bleeding occurred in 10 patients and was related to a therapeutic procedure in all cases.
A further 9 patients developed cholangitis, most cases being secondary to incomplete drainage.
The team identified several variables, derived from cannulation technique, associated with an increased risk for post-ERCP pancreatitis.
These were precut access papillotomy (20%), multiple cannulation attempts (15%), sphincterotome use to achieve cannulation (13%), pancreatic duct manipulation (13%), multiple pancreatic injections (12%), guidewire use to achieve cannulation (10%), and the extent of pancreatic duct opacification (10%).
They also determined patient characteristics associated with an increased risk of pancreatitis.
These included sphincter of Oddi dysfunction (22%) documented by manometry, previous ERCP-related pancreatitis (19%), and recurrent pancreatitis (16%).
Furthermore, pain during the procedure was an important indicator of an increased risk of post-ERCP pancreatitis.
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.
Dr Jo Vandervoort's team concluded, "The most frequent ERCP-related complication was pancreatitis, which was mild in the majority of patients".
"Specific patient- and technique-related characteristics that can increase the risk of post-ERCP complications were identified".