Does endoscopic retrograde cholangiopancreatography procedures for benign pathology treatment cause biliary reflux?

Abstract

Bile reflux is caused by the backward flow of duodenal fluid into the stomach. A retrospective cohort study was performed to estimate the prevalence and risk factors of bile reflux gastritis post-ERCP, and its endoscopic and histopathologic consequences on gastric mucosa. The study enclosed 58 patients with refractory epigastric pain and dyspeptic symptoms. They were split into two categories.; the control group (CG): 30 subjects who had never undergone any biliary interventions, and the post-ERCP group (PEG): 28 subjects who have had at least one of the following procedures for benign pathology treatment: endoscopic sphincterotomy (ES) or endoscopic stenting. In CG, the ages ranged from 25 to 68 years with a mean age ± SD of 42.1±12.42. In PEG: the ages ranged from 27 to 59 years with mean age ± SD of 39.25 ± 7.47. All participants had undergone clinical and laboratory assessment and gastroscopy for gastric aspirate analysis as well as gastric mucosa biopsy for histopathological examination. The study showed that the prevalence of bile reflux gastritis was found to be (16.7 %) in CG and (71.43 %) in PEG with a P value of 0.000. In both groups, diabetes, obesity, increased gastric bilirubin, and increased gastric pH were risk factors for bile reflux gastritis (r= 0.28, 0.42, 0.84, 0.66 respectively). However, there were no correlations between age, sex, epigastric pain, heartburn, vomiting, and the occurrence of bile reflux gastritis. In Conclusion, bile reflux gastritis is common post-ERCP being more among obese and diabetic patients.