Therapeutic Biliary and Pancreatic Endoscopy in Palestine-Gaza Strip; a Three Year Retrospective Audit

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a gold standard tool in diagnosis and mainly treatment of biliary and pancreatic disease. This invasive technique has well-described potential morbidity and mortality. However, no comprehensive information exists till date from Palestine. Aim: This study aimed to determine outcome and complications of ERCP procedures performed in the European Gaza Hospital, Gaza. Methods: a retrospective facility-based study was conducted on 103 consecutive patients underwent ERCP in the European Gaza Hospital from 2017 to 2019. Patients' records were reviewed and appropriate data were collected. Descriptive and multivariate logistic regression. Results: mean patients' age was 55.5±17.8 years, and 53.4% of them were females. Half of patients (50.5%) presented with jaundice as a chief complaint, and 62% had a past history of gallbladder stones and/or cholecystitis. Three quarter of ERCP procedures were elective, in which most common indication was obstructive jaundice resulted from choledocholithiasis (77.7%). successful cannulation was reported in majority of ERCP procedures (95.1%) and sphincterotomy was mainly intervened (90.3%). ERCP was performed mainly for therapeutic purpose either by clearance of common bile duct (CBD) or biliary stenting (67% and 20.4%, respectively). Most ERCPs time ranged between 30 to 60 minutes. overall complication rate was 6.8%, mainly bleeding (2.91%) followed by pancreatitis (1.94%). Predictors for risk of complications were doing pancreatic injection (OR: 18.8, CI95%: 2.18-162.45, P=0.008) and CBD clearance (OR: 0.15, CI95%: 0.03-0.86, p=0.033). Conclusion: despite reported morbidity and risk of mortality, ERCP remains a significant approach for management of pancreatico-biliary diseases.