Terapotik ERCP komplikasyonları için risk faktörleri: Tek merkezli prospektif çalışma*

Abstract

Other than pancreatitis, diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) can result in several complications - primarily cholangitis, bleeding, perforation and cardio-respiratory side effects. In this study, we investigated complications of therapeutic ERCP and the risk factors associated with these complications. We did a retrospective study on 100 patients who had undergone ERCP procedure by the same endoscopist and evaluated data regarding clinical and laboratory parameters obtained pre-, during and soon after the ERCP procedure. ERCP could not be done in two patients because of previous gastric operation and Billroth II type gastrojejunostomy and in another two patients who had obstructing duodenum tumor which prevented reaching the papilla. We did selective choledochal cannulation in 86 of 96 patients; nine cases had undergone precut sphincterotomy before selective cannulation, and in one case, percutaneous and endoscopic combined method had been used to cannulate the common bile duct. Totally, seven (7.29%) complications in five patients (5.2%) were observed as follows: one patient had pancreatitis, cholangitis and bleeding; one had cholangitis; one had pancreatitis and bleeding and two had bleeding. There was no mortality, though mild and moderate procedure-related morbidities were noted. All the patients who developed complications were female and two had had residual common bile duct stone. The female gender and residual bile duct stone were determined to be the main risk factors in therapeutic ERCP. After sphincterotomy and cleaning of the common bile duct, the cholangiographic images can miss small stones due to contrast material, and during the first 24 hours, the Oddi edema can prevent spontaneous passage of the residual stone. Thus, as was seen in one of our patients, pancreatitis, cholangitis and bleeding can develop in these cases. Thus, patients should be checked with scopes and in the case of a residual stone, extraction should be completed without delay rather than waiting for spontaneous release. In conclusion, specific patient- and procedure- related factors, including operator experience, can increase the risk of ERCP-related complications. Precise identification of risk factors for complications of ERCP is essential to recognize high-risk cases in which ERCP should be avoided if possible. Furthermore, use of noninvasive imaging modalities instead of diagnostic ERCP and performance of ERCP by an experienced endoscopist will decrease ERCP-related complications.