Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP).
Dr Chi-Liang Cheng and colleagues examined the potential patient- and procedure-related risk factors for post-ERCP pancreatitis.
The researchers conducted a prospective multicenter randomized study and collected data from160-variable database by a defined protocol on patients.
The team reported that 1115 patients underwent diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group.
The research team assessed whether prophylactic corticosteroids will reduce the incidence of post-ERCP pancreatitis.
Data were collected prior to the procedure, at the time of procedure, and 24 to 72 hours after discharge.
| Suspected sphincter of Oddi dysfunction was the indication for the ERCP in 34%|
|American Journal of Gastroenterology|
Post-ERCP pancreatitis was diagnosed and its severity graded according to consensus criteria.
Diagnostic ERCP with or without sphincter of oddi manometry was performed in 48% and therapeutic ERCP in 52%.
Suspected sphincter of Oddi dysfunction was the indication for the ERCP in 34%.
The team found that pancreatitis developed in 15%, graded mild in 10%, moderate in 4%, and severe in 1%.
The researchers noted no difference in the incidence of pancreatitis or the frequency of risk factors between the corticosteroid and placebo groups.
By univariate analysis, the incidence of post-ERCP pancreatitis was significantly higher in 19 of 30 investigated variables.
In the multivariate risk model, the team noted that minor papilla sphincterotomy was a significant risk factor with adjusted odds ratio.
Suspected sphincter of oddi dysfunction, history of post-ERCP pancreatitis, and age less than 60 years were also significant risk factors.
The team observed that more than 2 contrast injections into the pancreatic duct, and trainee involvement were risk factors.
Female gender, history of recurrent idiopathic pancreatitis, pancreas divisum, sphincter of Oddi manometry, were not risk factors.
The researchers noted that neither difficult cannulation, and major papilla sphincterotomy were risk factors for post-ERCP pancreatitis.
Dr Cheng's team concludes, “This study emphasizes the role of patient factors.”
"Age, sphincter of Oddi dysfunction , prior history of post-ERCP pancreatitis,
and technical factors are determining high-risk predictors for post-ERCP pancreatitis."