Quality in Endoscopic Retrograde Cholangiopancreatography—Incidence and Predictive Factors of Adverse Events

Abstract

Background and AimsIncidence of endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events varies between endoscopy units. We aimed to identify factors related to successful bile duct (BD) cannulation and to determine the incidence and predictive factors of post-ERCP adverse events. MethodsAbout 1103 ERCPs were evaluated from a prospective database over a 4-year period and 57 were excluded: age <18 years; incomplete procedure; surgically altered small bowel anatomy and refusal of informed consent. Factors associated with successful BD cannulation and predictive of post-ERCP adverse events were evaluated. ResultsOut of 1046 ERCPs analyzed, successful cannulation rate of native papilla of Vater was 91.3% (n = 639). Guidewire-assisted BD cannulation and choledocholithiasis were associated with higher native papilla cannulation rates (P = 0.02 and P < 0.001). Malignant biliary stricture and acute gallstone pancreatitis were associated with lower native papilla cannulation rates (P < 0.001 and P = 0.024). The incidence of post-ERCP adverse events was: Pancreatitis (PEP) 2.7% (n = 28), bleeding 0.8% (n = 8), cholangitis 0.7% (n = 7) and perforation 0.5% (n = 5). PEP risk was significantly higher in patients with native papilla compared with non-native papilla (rate of 3.6% and 0.6%, respectively, P = 0.005). In patients with native papilla, ≥2 unintentional pancreatic duct cannulations was the only independent predictive factor associated with PEP (odds ratio 2.371, 95% confidence interval: 1.003-5.605, P = 0.049). ConclusionCholedocholithiasis is associated with a higher cannulation rate while malignant biliary stricture and acute gallstone pancreatitis are associated with a lower BD cannulation rate. Patients with native papilla have a significantly higher risk of PEP with the only factor associated with PEP being 2 or more unintentional pancreatic duct cannulations.