The team evaluated the potential procedure- and patient-related risk factors for post-ERCP pancreatitis, over a wide spectrum of centers.
They reported their findings in the October issue of Gastrointestinal Endoscopy.
A total of 1963 consecutive ERCP procedures were prospectively studied at 11 centers (6 private, 5 university).
Complications were assessed at 30 days, by using established consensus criteria.
|Pancreatitis occured after 7% of ERCPs.|
| Gastrointestinal Endoscopy |
Pancreatitis occurred after 131 (7%) of the ERCP procedures (mild 70, moderate 55, severe 6).
Multivariate risk factors, with adjusted odds ratios (OR), included prior ERCP-induced pancreatitis (OR 5.4), suspected sphincter of Oddi dysfunction (OR 2.6), female gender (OR 2.5), normal serum bilirubin (OR 1.9), and absence of chronic pancreatitis (OR 1.9). In addition, biliary sphincter balloon dilation (OR 4.5), difficult cannulation (OR 3.4), pancreatic sphincterotomy (OR 3.1), and 1 or more injections of contrast into the pancreatic duct (OR 2.7) were risk factors.
Small bile duct diameter, sphincter of Oddi manometry, biliary sphincterotomy, and lower ERCP case volume were not found to be multivariate risk factors for pancreatitis.
However, endoscopists performing on average more than 2 ERCPs per week had significantly greater success at bile duct cannulation (97% versus 92%).
Combinations of patient characteristics, including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis, placed patients at increasingly higher risk of pancreatitis. This was regardless of whether ERCP was diagnostic, manometric, or therapeutic.
Dr Martin L. Freeman concluded on behalf of his group, "Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis."
"These data emphasize the importance of careful patient selection, as well as choice of technique, in the avoidance of post-ERCP pancreatitis," he added.