Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post‐endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Objectives The reported incidence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) varies between 2.5% and 14%. The aim of this study was to evaluate the incidence and severity of AEs in biliary ERCP and to specify the risk factors and preventive measures for post‐ERCP pancreatitis (PEP). Methods Patients with biliary disease with intact papilla were prospectively enrolled at 36 hospitals between April 2017 and March 2018. The primary outcomes were the incidence and severity of AEs. Results A total of 16,032 ERCP procedures were performed at the 36 hospitals during the study period and 3739 patients were enrolled. The overall incidence of AEs was 10.1% and ERCP‐related mortality was 0.08%. PEP developed in 258 cases (6.9%), bleeding in 33 (0.9%), instrumental AEs in 17 (0.5%), infections in 37 (1.0%), cardiovascular AEs in eight (0.2%), pulmonary AEs in eight (0.2%), drug reaction AE in one (0.03%), pain in 15 (0.4%), and other AEs in 15 (0.4%). Multivariable analysis showed significant risk factors for PEP were: female of younger age, pancreatic guidewire‐assisted biliary cannulation, temporary guidewire insertion into the pancreatic duct, total procedure time >60 min, and post‐ERCP administration of non‐steroidal anti‐inflammatory drugs. Effective preventive measures were prophylactic pancreatic stenting (PPS) and epinephrine spraying onto the papilla. Conclusions In patients with intact papilla who underwent biliary ERCP, the incidence of AEs was 10.1% and the mortality was 0.08%. PPS and epinephrine spraying may prevent PEP. Registration This study was registered in the University Hospital Medical Information Network (UMIN000024820).

The safety and efficacy of Ringer's solution loading with rectal diclofenac for prevention of post‐endoscopic retrograde cholangiopancreatography pancreatitis: The RESOLUTION‐PEP study

“…This patient was overweight (body mass index: 36.0%), which may have influenced prognostic factors for severe PEP. Previous studies have reported mortality rates of 0.1%–0.7% for PEP, 25 , 31 and the PEP‐only mortality rate in our study (0.4%) was similar to previous reports.…”

Incidence of adverse event associated with endoscopic retrograde cholangiopancreatography in the current era: Pursuit of a lower incidence of postendoscopic retrograde cholangiopancreatography pancreatitis

“…In this issue of Digestive Endoscopy, Fujita et al conducted a multicenter prospective cohort study to examine the incidence of adverse events associated with biliary ERCP. 8 This study collected data regarding the patient characteristics, the attending endoscopists, and the actual procedures to analyze the factors associated with PEP. A total of 3739 patients were registered for this study from 36 institutions between April 2017 and March 2018, and the overall rate of adverse events was 10.08%, with 0.08% mortality.…”

“…In this issue of Digestive Endoscopy , Fujita et al . conducted a multicenter prospective cohort study to examine the incidence of adverse events associated with biliary ERCP 8 . This study collected data regarding the patient characteristics, the attending endoscopists, and the actual procedures to analyze the factors associated with PEP.…”

Фактори Ризику Панкреатиту Після Транспапілярних Ендоскопічних Втручань

“…Багатофакторний аналіз показав, що значними факторами ризику післяпроцедурного панкреатиту були: жінки молодшого віку, жовчовивідна канюляція підшлункової залози, тимчасове введення дроту в протоку підшлункової залози, загальний час процедури >60 хв та введення нестероїдних протизапальних препаратів після ЕРХПГ. Ефективними попереджувальними заходами були профілактичне стентування підшлункової залози та розпилення адреналіну на сосочок [5].…”

“…У групі високого ризику частота післяпроцедурного панкреатиту становила 13,4 %, і всі тяжкі/летальні випадки були саме в групі високого ризику. Факторами ризику були: післяпроцедурний панкреатит в анамнезі (ВШ 4,2), інтактний сосочок (ВШ 2,4), утруднена канюляція (ВШ 1,9), жовчовивідна канюляція підшлункової залози за допомогою проводника (ВШ 2,2), ін'єкція підшлункової залози (ВШ 2.1), внутрішньопротокова ультрасонографія підшлункової залози (IDUS)/відбір зразків із протоки підшлункової залози (ВШ 2.2) та жовчний IDUS/відбір зразків із жовчних шляхів (ВШ 2.8) [5].…”