3357 Complications of diagnostic and therapeutic ercp.

Abstract

Background: Studies suggest that therapeutic intervention during ERCP increases the procedure related complication rate. Aim: To report our experience with complication rate secondary to diagnostic and therapeutic ERCP at a tertiary care referral center. Methods: 1182 ERCP s were done between July 1995 and September 1999. Patients were divided into five groups: ERCP alone: n=387, ERCP and endoscopic sphincterotomy (ES): n=436, ERCP and sphincter of Oddi manometry (SOM): n=105, ERCP+ SOM+ ES: n=102, and needle knife sphincterotomy (NKS) ± ES: n=152. Complications were assessed using Cotton et al. criteria by review of hospital records and direct follow-up phone calls. Results: See table below. The total morbidity was 9.8%. Three of the 8 with retroperitoneal perforation required surgical management. No mortality was observed. Multifactor analysis revealed risk groups for pancreatitis to be obesity (16.8%) vs. nonobese (3.6%), pancreatic SOM (35.2%) vs. biliary SOM (12.5%), and common bile duct diameter: ≤ 5mm (18.7%), 6-9mm (5.3%), ≥ 10mm (1.7%). All except one perforation occurred in cases with duct diameter of ≤ 5mm. Conclusions: SOM especially pancreatic is associated with a significant risk of pancreatitis. NKS, although an effective biliary access technique in experienced hands, should be reserved only when therapeutic intervention is suspected.