COMPLICATIONS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN KURDISTANCENTER FOR GASTROENTEROLOGY AND HEPATOLOGY

Abstract

Background 
 ERCP has become widely available for the diagnosis and treatment of benign and malignant pancreaticobiliary diseases.In this retrospective study, the overall complications rates for therapeutic ERCP were identified in Kurdistan Center for Gastroenterology and hepatology-Sulaimani-Kurdistan region-Iraq.
 Patients and Methods
 This retrospective case series was carried out in Kurdistan center for gastroenterology and hepatology in Sulaimani city-Iraq from January 2014 to January 2015. The records of 806 ERCP were evaluated to collect procedure related data and the overall complications rate for diagnostic and therapeutic ERCP.
 Results
 All cases examined by ERCP in the KCGH in Sulaimani over a period of one year (from January 2014 to January 2015) were 806, 471 females (58.43%) and 335 males (41.56%). Less than quarter of patients were referrals from Iraqi governorates other than Sulaimani governorate. The mean duration of ERCP procedure was 27.5 min. Deep cannulation was successful in 749 (92.92%) patients. There were 57 (7.07%) failure of cannulation. In cases who had successful cannulation a cholangiogram was obtained which showed bile duct dilatation. In cases of failed cannulation pancreatic stent deployed in 26 (3.22%). Endoscopic sphincterotomy was performed in 472 (58.56%) patients, followed by stone extraction in 341 (96.05%) patients, stenting of common bile duct in 422 (52.35%) ,stent removal in second session of ERCP. The overall complications rate was 9.42%. Post-ERCP pancreatitis was the most common and occurs in 34 patients (4.23%), Bleeding occurred in 19 patients (2.35%) and was related to a therapeutic procedure in all cases. Sixteen patients had cholangitis (1.98%), most cases being secondary to incomplete drainage. There were 4 perforations (0.49%). All other complications totaled 1.12%.
 Conclusion
 Despite the potential benefits of ERCP for the treatment of benign and malignant pancreaticobiliary diseases, it is associated with morbidity and risk of mortality. The most frequent ERCP-related complication was pancreatitis. Bleeding was second complication and mostly associated with sphincterotomy. Other complications such as cholangitis and perforation were rare. Patients’ comorbidities and therapeutic procedures can increase the risk of post-ERCP complications.Our interventions and their complications rates are comparable to those reported in other countries.