ERCP-related adverse events: incidence, mechanisms, risk factors, prevention, and management

Rivas, Angelica; Pherwani, Simran; Mohamed, Rachid; Smith, Zachary L.; Elmunzer, B. Joseph; Forbes, Nauzer

doi:10.1080/17474124.2023.2277776

Cited by 6 publications

(4 citation statements)

References 118 publications

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“…Therefore, clarifying the independent risk factors for post-ERCP complication of pancreatitis and early identi cation and screening of high-risk groups can, to a certain extent, play a preventive role and improve the prognosis of patients. Existing identi ed risk factors include intraoperative pancreatic visualization, long intubation time, and high number of intubations (5). There are three main strategies for preventing PEP in this study: patient factors, pharmacologic prophylaxis, and surgical-related factors, and despite the advances that have been made in these areas, current preventive measures have only reduced the risk of PEP and the current means of treating PEP are still limited.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis of 145 randomized controlled trials from 1977 to 2022 noted an overall incidence of PEP of 10.2% and a mortality rate of 0.2% (2,4).The incidence of PEP is in uenced by a number of factors including gender, age, history of previous pancreatitis, previous PEP, undilated common bile duct, bilirubin levels, sphincterotomy, metal biliary stent placement ( Fig. 1), surgeon factors, and di cult intubation (5). And duodenal papilla morphology is also an important factor (6).…”

Section: Introductionmentioning

confidence: 99%

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Unraveling Risk Factors and Disparities in Post-ERCP Acute Pancreatitis: A Clinical Exploration into Oddi Sphincter Morphology at the Duodenal Papilla

Yang,

Du,

Liu

et al. 2024

Preprint

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Background To investigate the risk factors for pancreatitis and their variability after endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary tract diseases. Methods The clinical data of a total of 234 patients who underwent ERCP for biliary tract diseases at the First Affiliated Hospital of Dalian Medical University from June 2023 to November 2023 were retrospectively analyzed, and a total of 149 patients were enrolled after inclusion and exclusion criteria were applied.This study has been approved by the Ethics Committee of the First Affiliated Hospital of Dalian Medical University, and the relevant guidelines and regulations have been strictly followed. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Dalian Medical University, and the relevant guidelines and regulations have been strictly followed.According to the morphology of Oddi type sphincter of duodenal papilla, patients were classified as normal papillary muscle morphology and normal sphincter. According to the Oddi sphincter morphology of the duodenal papilla, the patients were divided into two layers: normal papillary muscle morphology and abnormal papillary muscle morphology, retrieved their baseline data, and then divided into the PEP group and non-PEP group according to the occurrence of PEP, based on the different stratification and grouping of the clinical baseline data, and the statistically significant results of the difference in the analysis of the difference in the relevant visualization. Patients were divided into study group (n=34, with PEP) and control group (n=115, without PEP) according to whether they had post-ERCP pancreatitis (PEP) or not, and their clinical baseline data were retrieved and compared. Their statistically significant risk factors for PEP were analyzed based on Lasso regression and logistic regression. Results In the DPS=0 group, the factors significantly associated with PEP are SA,PH,PS,IT,OSD,PAP,PI,NRG,PAG,PLG.In the DPS=1 group, the risk factors are BMI,SA,PH,IT,OSD,PAP,APG,PAG and PLG. The risk factors that are common between the groups for the occurrence of PEP are SA,PH,IT,OSD,PAP,PAG,PLG. OSD, PAP, PAG, PLG. In the between-group comparison analysis of variance, the most significant differences between groups are IT (t: 2.449, P: 0.0220) and OSD (t: -3.647, P: 0.0012). In the Lasso regression analysis and logistic regression analysis, it has been found that: gender, C, PS, IT, PI, OSD, PAP, PAR, NRG (2), TBG (2), PG, PAG, PLG (1), and ET are independent risk factors for the promotion of PEP as its occurrence. Conclusion According to DPS=0 and DPS=1 stratified intergroup correlation comparison variability analysis we have found that the common risk factors associated with PEP are SA,PH,IT,OSD,PAP,PAG,PLG, and the risk factors with the most significant intergroup variability are IT and OSD.Gender, C, PS, IT, PI, OSD, PAP, PAR, NRG (2), TBG(2), PG, PAG, PLG(1), and ET are independent risk factors for PEP. This study can assist clinicians to make a comprehensive and reasonable assessment of patients who are about to undergo ERCP, and to make relevant clinical interventions in a timely manner, so as to improve the prognosis of the patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unraveling Risk Factors and Disparities in Post-ERCP Acute Pancreatitis: A Clinical Exploration into Oddi Sphincter Morphology at the Duodenal Papilla

Yang,

Du,

Liu

et al. 2024

Preprint

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“…A study on children and young adults identi ed factors associated with the development of PEP, including procedural factors such as pancreatic duct injection, cannulation, and sphincterotomy, anatomic factors such as pancreas divisum, complexity scoring, and patient related factors such as a prior history of PEP [12]. The incidence of PEP in the general population is reported to be 3-10% [2], while in our study, the incidence was 14.2%, higher than reported in the literature. We attribute this higher incidence in children to narrower pancreatic ducts and smaller papillary openings compared to adults, making cannulation and pancreatic stent insertion more challenging.…”

Section: Pepmentioning

confidence: 99%

“…Endoscopic retrograde cholangiopancreatography (ERCP) is a common method for diagnosing and treating biliary and pancreatic diseases, playing a crucial role in diseases such as biliary obstruction, cholangitis, biliary and pancreatic strictures, pancreatitis and its complications, pancreatic tumors, and dysfunction of the Oddi sphincter [1]. ERCP has gained widespread application in adults; however, due to its technical complexity, it has the highest incidence of adverse events (AE) among all commonly used endoscopic procedures [2]. Therefore, enhancing clinicians' understanding of ERCP-related AEs is essential.…”

Section: Introductionmentioning

confidence: 99%

ERCP-related Adverse Events in Pediatric Patients: A 10-Years Single-Site Review

Li,

Hou

et al. 2024

Preprint

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Purpose This retrospective analysis aimed to assess the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients by examining ERCP-related adverse events (AEs) occurring over a decade at a single center. Methods Pediatric patients under 18 years old who underwent ERCP at the Second Hospital of Hebei Medical University from 1/2013 to 11/2023 were included. ERCP-related AEs were defined according to ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Clinical data of patients experiencing ERCP-related AEs were obtained from electronic medical records for analysis. Results Over the past decade, a total of 76 pediatric patients underwent 113 ERCP procedures, including 26 patients who underwent repeat ERCP, totaling 63 procedures. There were 32 males and 44 females, with a median age of 13 years (range 3 years and 5 months–17 years and 9 months). Among all ERCP procedures, 14 (12.4%) were diagnostic and 99 (87.6%) were therapeutic, with a 100% success rate. 16 cases (14.2%) of ERCP-related AEs, all post-ERCP pancreatitis (PEP), were observed, while no other AEs defined by ESGE such as bleeding, perforation, cholangitis, cholecystitis, or sedation-related events were noted. Additionally, 23 cases (20.4%) of ERCP-related AEs not included in the ESGE definition were observed, including post-ERCP abdominal pain in 20 cases (17.7%), post-ERCP nausea and vomiting in 2 cases (1.8%), and unplanned reoperation in 1 case (0.9%). In the 26 cases of pediatric patients who underwent repeat ERCP, we observed that AEs occurred in 15 cases (57.7%) during their initial ERCP, which was much higher than the overall average level. Conclusions Post-ERCP abdominal pain and PEP are the most common ERCP-related AEs in pediatric patients, while severe AEs such as bleeding and perforation are rare. The incidence of AEs after initial ERCP in pediatric patients who received repeat ERCP is higher than the overall average level. Based on our center's experience, we believe that ERCP can be safely performed in children over 3 years old with biliary and pancreatic diseases and obtain reliable clinical benefits. However, active monitoring and management of ERCP-related AEs are essential to improve the clinical outcomes of pediatric ERCP.

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ERCP-Related adverse events in pediatric patients: a 10-years single-site review

Li,

Hou

et al. 2024

Pediatr Surg Int

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This retrospective analysis aimed to assess the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients by examining ERCP-related adverse events (AEs) occurring over a decade at a single center. MethodsPediatric patients under 18 years old who underwent ERCP at the Second Hospital of Hebei Medical University from 1/2013 to 11/2023 were included. ERCP-related AEs were de ned according to ERCPrelated adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Clinical data of patients experiencing ERCP-related AEs were obtained from electronic medical records for analysis. ResultsOver the past decade, a total of 76 pediatric patients underwent 113 ERCP procedures, including 26 patients who underwent repeat ERCP, totaling 63 procedures. There were 32 males and 44 females, with a median age of 13 years (range 3 years and 5 months-17 years and 9 months). Among all ERCP procedures, 14 (12.4%) were diagnostic and 99 (87.6%) were therapeutic, with a 100% success rate. 16 cases (14.2%) of ERCP-related AEs, all post-ERCP pancreatitis (PEP), were observed, while no other AEs de ned by ESGE such as bleeding, perforation, cholangitis, cholecystitis, or sedation-related events were noted. Additionally, 23 cases (20.4%) of ERCP-related AEs not included in the ESGE de nition were observed, including post-ERCP abdominal pain in 20 cases (17.7%), post-ERCP nausea and vomiting in 2 cases (1.8%), and unplanned reoperation in 1 case (0.9%). In the 26 cases of pediatric patients who underwent repeat ERCP, we observed that AEs occurred in 15 cases (57.7%) during their initial ERCP, which was much higher than the overall average level. ConclusionsPost-ERCP abdominal pain and PEP are the most common ERCP-related AEs in pediatric patients, while severe AEs such as bleeding and perforation are rare. The incidence of AEs after initial ERCP in pediatric patients who received repeat ERCP is higher than the overall average level. Based on our center's experience, we believe that ERCP can be safely performed in children over 3 years old with biliary and pancreatic diseases and obtain reliable clinical bene ts. However, active monitoring and management of ERCP-related AEs are essential to improve the clinical outcomes of pediatric ERCP.

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ERCP-related adverse events: incidence, mechanisms, risk factors, prevention, and management

Cited by 6 publications

References 118 publications

Unraveling Risk Factors and Disparities in Post-ERCP Acute Pancreatitis: A Clinical Exploration into Oddi Sphincter Morphology at the Duodenal Papilla

Unraveling Risk Factors and Disparities in Post-ERCP Acute Pancreatitis: A Clinical Exploration into Oddi Sphincter Morphology at the Duodenal Papilla

ERCP-related Adverse Events in Pediatric Patients: A 10-Years Single-Site Review

ERCP-Related adverse events in pediatric patients: a 10-years single-site review

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