4623 Closure of the accessory pancreatic duct is the risk factor for post-diagnostic ercp pancreatitis.

Abstract

Background: Acute pancreatitis is the most common complication of ERCP. Many risk factors such as direct mechanical trauma, hydrostatic forces, chemical effects of contrast agent injected under pressure, and microbial contamination for post-diagnostic ERCP pancreatitis have been reported. However, whether patency of the accessory pancreatic duct (APD) influences post-diagnostic ERCP pancreatitis is unknown. Aim: To evaluate the closure of the APD and several other risk factors for post-diagnostic ERCP pancreatitis. Patients and Methods: This study was conducted on 536 patients from 836 consecutive ERCPs over the past seven years. Serum pancreatic enzymes (amylase, lipase, elastase-1, trypsin, pancreatic secretary trypsin inhibitor {PSTI}) and neutrophil counts were evaluated at pre- , 5, 24, 48 and 72 hours after ERCP. Percent of increase compared with pre- ERCP value also estimated respectively. The severity of pancreatitis was classified into three groups (severe, moderate, or mild) according to the established criteria. By multivariate analysis, twelve factors: age, gender, cannulation frequency, bile duct cannulations, pancreatic contrast injections, closure of the APD, pre-ERCP values of serum pancreatic enzymes and neutrophil counts were evaluated. Results: Overall, 14/536 (2.6%) patients developed pancreatitis; 6 mild, 6 moderate, 2 severe. Patency of APD was significantly lower in the pancreatitis group than that in the non-pancreatitis group (pancreatitis vs. non-pancreatitis: 2/14, 14.3% vs. 173/522, 33.1%, respectively). The rate of pancreatitis was significantly higher in the closed APD group than in the patent APD group and two cases with severe pancreatitis were documented only in the closed APD group (closed vs. patent: 12/246, 4.9% vs. 2/175, 1.1% and 2 severe, 5 moderate, 5 mild vs.1 moderate, 1 mild). In the non-pancreatitis group, serum pancreatic enzyme values at pre-ERCP were similar between closed and patent APD groups, whereas the percent increases at 24 and 48 hours after the procedure in the closed group were higher than those in the patent group. By multivariate analysis, the significant risk factors were: female sex, cannulation frequency, closure of APD, bile duct cannulations, and pancreatic contrast injections. Conclusion: Closure of APD also carries a high risk of developing post-diagnostic ERCP pancreatitis. The appropriate use of this new prognostic indicator may provide a significant benefit in the early diagnosis of post-ERCP pancreatitis.