ERCP with Cholangiopancreatoscopy (CP) Is Associated with Higher Rates of Endoscopic Complications Than ERCP Alone

Abstract

Background: Whether ERCP complications are higher when CP is performed is unknown. Methods: Our prospectively entered database was queried for ERCPs and complications. CPs were extracted. A data collection sheet included indications, interventions, complications by consensus criteria, and other adverse events (unplanned medical evaluation, cardiopulmonary, sedation-related, infection). Patients undergoing sphincter of Oddi manometry (SOM) were excluded. STATA 8.2 was used for analyses. Results: Between July 2001 and October 2007, a total of 4214 ERCP's were performed, of which 337 (8.0%) were SOM and excluded. Of the 3877 remaining ERCP's, CP was performed in 402 (10.4%). 129 adverse events (AE) were reported and analyzed (101 after ERCPs, 28 after CPs). In patients with AEs, indications for ERCP and CP, respectively, included: evaluation of biliary (CBD) (35.6%, 46.4%) and pancreatic (PD) stricture (16.8%, 17.9%), therapy of CBD stones (16.8% and 32.1%) and PD stones (6.9% and 10.7%); sphincterotomies were performed in 59.4% and 28.6% of procedures. Pancreatoscopy comprised 7/28 (25.0%) of CPs. Interventions performed at time of ERCP with CP in patients with AEs: CBD (N = 4) and PD (N = 3) stricture dilation, CBD (N = 15) and PD (N = 4) tissue sampling, CBD (N = 4) and PD (N = 2) EHL, and prophylactic or therapeutic PD stents (N = 5). CP diagnoses included CBD (N = 5) and PD stones (n = 3), PSC (n = 3), CCA (n = 6), chronic pancreatitis (n = 2), IPMN (n = 4), and other (n = 5). Reported AEs (see Table) were significantly higher in the CP compared to ERCP group [28/402 (7.0%) vs 101/3475 (2.9%)], (OR 2.50, 95% CI [1.56-3.89]). Subgroup analyses revealed a significantly higher rate of cholangitis (1.0% vs 0.2%, OR 4.98, 95%CI [1.06-19.67]) and a trend toward a higher rate of pancreatitis (2.2% vs 1.3%, OR 1.75, 95%CI [0.74-3.65])and perforation (1.0% vs 0.3%, OR 3.16, 95%CI [0.73-10.75] in the CP group. Conclusions: 1) Adverse events for cholangiopancreatoscopy are more than double that of ERCP when SOM patients are excluded. 2) CP is associated with significantly higher consensus criteria complications 3) Subgroup analysis showed significantly higher rates of cholangitis in the CP group likely related to fluid irrigation 4) The increased risk for complications should be discussed with patients undergoing ERCP when CP is planned. Tabled 1Consensus Complications and Other Adverse Events Procedures with Complications Pancreatitis ∗ Total complications by consensus criteria was significantly higher for ERCP with CP (4.2% vs 2.2%. OR 2.00, 95%CI [1.10-3.46] Perforation ∗ Total complications by consensus criteria was significantly higher for ERCP with CP (4.2% vs 2.2%. OR 2.00, 95%CI [1.10-3.46] Bleeding ∗ Total complications by consensus criteria was significantly higher for ERCP with CP (4.2% vs 2.2%. OR 2.00, 95%CI [1.10-3.46] Cholangitis ∗ Total complications by consensus criteria was significantly higher for ERCP with CP (4.2% vs 2.2%. OR 2.00, 95%CI [1.10-3.46] Unplanned Medical Evaluation Cardiopulmonary/Sedation Events Other CP(N = 28) 9 4 0 4 6 2 3 ERCP(N = 101) 45 11 12 7 8 10 8 ∗ Total complications by consensus criteria was significantly higher for ERCP with CP (4.2% vs 2.2%. OR 2.00, 95%CI [1.10-3.46] Open table in a new tab