6985 Severe and fatal complications after diagnostic and therapeutic ercp in korea.

Abstract

Overall complication rates of ERCP have been reported in 4-10% after diagnostic or therapeutic ERCP. Even though severe and fatal complications after ERCP are less than 1%, those embarrass the endoscopists if those complications occurred. This is the multicenter study to analyze the severe and fatal complications after ERCP in Korea.We have collected severe and fatal complications after ERCP occurring between 1 october 1994 and 3 september 1999. Case notes were reviewed, along with laboratory reports and readiographs. The severe and fatal complications were classified according to the criteria suggested by Cotton et al.Severe and fatal complications were in 27 cases (0.23%, mean age 57.1 ±18.5 yrs, M:F=14:13) of 11,901 total number of ERCP during the study period, severe complications in 20 cases (0.17%), and fatal complications in 7 cases (0.06%). The most frequent severe complications were post ERCP perforation, which occurred in 11 cases(55%); 9 cases underwent endoscopic sphincterotomy, and 2 cases perforated by guide wire without endoscopic sphincterotomy(ES). 6 cases(30%) suffered pancreatitis; 4 of these underwent precut in 2 cases and ES in 2 cases. Cholangitis was in 2 cases, and bleeding in 2 cases. Severe complications were related with 14 cases of ES and 4 cases of diagnostic ERCP. Fatal complications were cholangitis in 3 cases (42.9%), perforation in 3 cases (42.9%), and pancreatitis in 1 case. Fatal complications were strongly associated with ES. The causes of death were necrotizing pancreatitis in 1 case, peritonitis in 3 cases and septic cholagitis in 3 cases. In conclusion, perforation was an important cause of severe and fatal complications after ERCP in Korea. ERCP, even for diagnostic purposes, is associated with serious complications.