Post-ERCP Pancreatitis: Single Center Experience

Abstract

Purpose: Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography(ERCP). The aim of our study is to determine the incidence of post ERCP pancreatitis and predictors associated with this complication at a single referral center. Methods: Between May 2007 and February 2009, data was collected prospectively from 800 consecutive ERCPs performed at a single referral center and entered into a database. Univariate (Fisher's exact test) and multivariate (multivariate logistic regression) analyses were used to identify patient and procedural risk factors associated with post-ERCP pancreatitis. Analyses were performed with SAS version 9.1.3 (SAS Institute Inc, Cary, NC). Results: Of the 800 ERCPs analyzed, 75% were therapeutic and 25% were diagnostic. The overall post-ERCP complication rate was 27/800 (3.4%). The most common complication was pancreatitis in 18/27 (67%) of cases. The severity of the pancreatitis was mild in 13/18 (78%), moderate in 4/18 (22%) and severe in 1/18 (6%). Other significant complications were bleeding in 4/27 (15%), perforation in 1/27 (4%) and cardiovascular complications in 2/27 (7.4%). There were no fatalities. Risk factors significantly associated with post-ERCP pancreatitis identified by univariate analysis were female gender, sphincter of oddi manometry, ampullectomy, pancreatic sphincterotomy and biliary sphincterotomy. Trainee participation was significantly less likely associated with pancreatitis (significantly less pancreatitis with > 50% trainee hands on time). Patient's age, race/ethnicity, patient's ASA grade, procedure time, endoscopist, difficulty grade of ERCP and prophylactic or therapeutic pancreatic duct stent placement had no significant association with pancreatitis. After adjusting for relevant confounders, ampullectomy and pancreatic sphincterotomy were identified as independent risk factors for post-ERCP pancreatitis. Of 15 ampullectomy cases, 6 had prophylactic pancreatic duct (PD) stents placed after the procedure. Pancreatitis did not occur in the stented group whereas two patients who underwent ampullectomy without prophylactic PD stent placement developed pancreatitis (0% vs. 22%). Conclusion: Pancreatitis was the most common complication to develop following ERCP. The incidence of pancreatitis is similar to that reported from other major ERCP centers. Ampullectomy and pancreatic sphincterotomy were identified as independent risk factors for post-ERCP pancreatitis. It appears that prophylactic PD stents may confer a protective effect in minimizing post ERCP pancreatitis in patients with ampullectomy. Future large sample size studies are warranted to confirm these findings.