Study on the risk factors of complications resulted from endoscopic retrograde cholangiopancreatography

Xiaobo Peng ,Enqiang Linghu ,Fang Cai ,Hongbin Wang ,Xiangdong Wang ,Jiangyun Meng ,Yunsheng Yang ,Hong Du ,Wen Li

doi:10.3760/cma.j.issn.1003-0603.2010.04.008

Abstract

Objective To study the risk factors of the complications of endoscopic retrograde cholangiopancreatography (ERCP). Methods Data were collected from patients who had undergone diagnostic and/or therapeutic ERCP during August 2005 and June 2007 in Gastro-enterologic Endoscopy Center of the Chinese PLA General Hospital. ERCP complications were recorded and analyzed by univariate analysis. Results The success rate of diagnostic and/or therapeutic ERCP were 96.8% (836/864) in 864 patients. The main factors which impeded a successful ERCP were: blockage of the duodenal papilla by tumors so that the guide wire could not pass through it, stenosis and obstruction of the bowel due to tumors, ulcer, or other lesions, and the endoscope could not be introduced into the descending part of duodenum. Complications occurred in 105 cases (12.2%), including post-ERCP panereatitis (PEP) in 49 cases (5.7%), cholangitis in 37 cases (4.3%), bleeding in 15 cases (1.7%) and perforation in 4 cases (0.5%). The univariate analysis showed that the main risk factors of PEP were lengthy cannulation time (longer than 60 minutes, χ~2=5.22, P=0.022), the pancreatic duet imaging (χ~2=6.83, P=0.009), sphincter of Oddi dysfunction (SOD, χ~2=19.89, P=0.000) and normal serum bilirubin (χ~2=4.02, P=0.045). The risk factors of acute eholangitis were malignancies (χ~2= 16.39, P=0.001), a history of bile duct calculus (χ~2=7.48, P=0.006), high bile duct obstruction (χ~2=67.13, P=0.000) and biliary tract therapeutic ERCP (χ~2=6.39, P=0.012). Conclusion The incidence of ERCP complications is related to the patients' intrinsic factors and the doctors' technical proficiency. An understanding of risk factors in patients and improve the skill of the operator are the key points to reduce or avoid critical complications after ERCP. Key words: Endoscopic retrograde cholangiopancreatography; Complications; Post-endoscopic retrograde cholangiopancreatography pancreatitis ; Infection

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