Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors.

Abstract

Pancreatitis and hyperamylasaemia are common complications of ERCP and this study was designed to explain which operative and patient factors predispose to them. A 1 year prospective study of consecutive patients in a single operator centre with detailed attention to technical factors and the findings. Four hundred and thirty ERCPs were performed. Pancreatitis occurred in 12 cases (2.8%). Amylase results were available in 407 cases; 17 were excluded because of pre-operative hyperamylasaemia (n = 5) and because of pancreatitis (n = 12). Of the remaining 390, 30 (7.7%) had hyperamylasaemia. Pancreatitis and hyperamylasaemia usually occurred after difficult procedures in which pancreatography was achieved. Smaller common bile-ducts, pre-cut papillotomy and some preoperative indications also significantly increased the risk of pancreatitis, while prior papillotomy was protective. Pancreatitis occurred in patients with a younger median age (52.5 vs 68.0; P < 0.05) and was more common in women (F:M = 11:1 vs 241:177; P < 0.05). Operative factors are, in part, responsible for the development of pancreatitis and hyperamylasaemia but the age and sex of the patient also appear to be important.