Risk Factors for Post‐endoscopic Retrograde Cholangiopancreatography Pancreatitis: Prospective Single‐institution Study

Abstract

Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP), and hyperamylasemia after ERCP is common. The aim of the present study was to examine the potential patient-and procedure-related risk factors for post-ERCP pancreatitis including hyperenzymenia in a prospective study. Data were collected prospectively on patient characteristics and endoscopic techniques from 184 ERCP performed at a single referral center and entered into a database. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after procedure. The primary end-point was the incidence of post-ERCP pancreatitis and the secondary objective was the incidence of hyperamylasemia. Of the 184 patients enrolled, diagnostic ERCP was performed in 37 (20.1%) and therapeutic ERCP in 147 (79.9%). Pancreatitis developed in two patients (1.1%) and was graded mild in one (0.5%) and severe in the other (0.5%). Hyperamylasemia occurred in 14 patients (7.6%). Six investigated variables, female gender, therapeutic ERCP, major papilla sphincterotomy, stenting, difficult cannulation, and bile duct diameter were not significant risk factors for post-ERCP pancreatitis. Although there was no significant factors in pancreatitis, the number of cannulations and precut sphincterotomies were significantly related to hyperamylasemia. The present study emphasizes a technical factor (difficult cannulation) as the determining high-risk predictors for post-ERCP pancreatitis.

Determining the Risk Factors of Complications Due to Endoscopic Retrograde Cholangiopancreatography

“…The absence of any significant effect of the practice of experienced endoscopists on all complications could be attributed to the fact that the majority of cases (67.5%), as well as ERCP cases that had been tried and failed in other centers, besides the complicated ones were performed by experienced endoscopists at our hospital. Difficult cannulation and technical challenges are cited as risk factors for all complications [5,30]. In our study, ERCP time and cannulation time were assessed to be independent risk factors, which reflects the difficulty of the procedure and the need for applied technical maneuvers.…”

Preventive Role of Wire-Guided Cannulation to Reduce Hyperamylasemia and Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

“…In some studies, pancreatitis was noted as the most common complication of ERCP [ 12 ]. The incidence of this complication had a wide range according to recent large prospective studies from 1% to 19.5% [ 13 – 17 ]. In our study, overall incidence rate of pancreatitis was estimated as 3.3%.…”

“…Furthermore, in their trial, although the guidewire technique improved the success rate for biliary cannulation during ERCP, it could not prevent the incidence of post-ERCP pancreatitis compared to the conventional contrast technique [ 5 ]. In another study by Tsuyuguchi et al difficult cannulation technique and stenting were not significant risk factors for post-ERCP pancreatitis [ 13 ]. It seems that their adverse findings could be due to difficult wire passages that resulted in injury to the papilla or the use of this technique as rescue method in patients with failed conventional cannulation.…”