Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Monocentric Retrospective Study of 2364 ERCP Procedures in 1275 Patients

Abstract

Background: Acute pancreatitis is considered a relevant major complication following endoscopic retrograde cholangiopancreatography (ERCP). According to literature data, the incidence varies between 1.6% and 17%. In the present study, we assessed incidence, severity, and risk factors of post-ERCP pancreatitis in our institution. Patients and Methods: A total of 2364 ERCP procedures performed in 1275 patients (mean age 59 years, 50% male) during the years 2004 - 2008 were included into the study. Post-ERCP pancreatitis was defined as acute abdominal pain within 48 h following ERCP with at least 3-fold elevated levels of serum lipase and requirement of analgesic drugs for at least 24 hours. Severity of pancreatitis was determined according to the Imrie score. Statistical analysis was performed for hospital duration, time interval of pain and need for analgesic drugs as equivalent morphine dose. Results: In our cohort study, 1676 out of 2364 ERCPs (71%) included interventions: endoscopic sphincterotomy 27%, placement of self-expanding metal stent 3%, plastic stent insertion 41%, calculus extraction 16%, intraductal ultrasound 18%, transpapillary biopsy 16%. A total of 51/2364 patients (2,2%) developed post-ERCP pancreatitis: In 92% of these cases (47/51 patients), patients suffered from mild pancreatitis, 4/51 patients developed severe pancreatitis. Hospital duration, time interval of pain and need for analgesic drugs were significantly higher in patients suffering from severe pancreatitis (p ≤ 0.01). Subgroup analysis revealed differences in the way interventions were performed: In the post-ERCP pancreatitis group, significantly more sphincterotomies, transpapillary biopsies, and intraductal ultrasound examinations were performed (p < 0.001). The odd's ratio for developing post-ERCP pancreatitis was 3.02 in patients receiving transpapillary biopsies, 2.82 in patients undergoing intraductal ultrasound, 3.8 in patients with sphincterotomy, and 3.4 in patients with juxtapapillary diverticulum, while patients with choledocholithiasis did not have a higher odd's ratio of developing a post-ERCP pancreatitis. The implantation of a plastic stent revealed a protective benefit with an odd's ratio of 0.70. Conclusions: ERCP is a safe method with low risk for developing acute pancreatitis even if the vast majority of ERCPs is therapeutic. If acute pancreatitis occurs the majority of patients develop self-limiting mild pancreatitis. As risk factors we could identify patients with juxtapapillary diverticulum and those having undergone intraductal ultrasound, sphincterotomy, and transpapillary biopsy.