Quality in Endoscopic Retrograde Cholangiopancreatography: Adverse Events and Their Predictive Factors

Aims To report incidence of adverse events and identify risk factors for post-ERCP pancreatitis (PEP), bleeding, cholangitis, cholecystitis and perforation.

Methods ERCPs performed between October 2016 and July 2019 registered in a prospective database at a tertiary referral centre were analysed. ERCP related adverse events were assessed by analysing clinical, radiological and laboratory data until hospital discharge. From 1103 procedures initially evaluated, 57 were excluded for the following reasons: age<18 years; incomplete procedure (gastrointestinal stenosis, food stasis, pre-procedure cardiovascular instability); post-surgery altered anatomy; refusal of informed consent. A final study population of 1046 procedures were evaluated.

Results Median age was 75.7 (18 – 100) years with 546 (51.2 %) male patients. Native papilla was present in 716 (68.5 %) procedures. Native papilla successful cannulation rate was 91.3 % (639 procedures) and overall successful papilla cannulation rate was 93.2 % (975 procedures). Guidewire assisted biliary cannulation and choledocholithiasis as an indication were associated with a higher native papilla cannulation rate (p = 0.02 and p<0.001). Lower cannulation rate was associated with malignant biliary stenosis and acute gall stone pancreatitis (p<0.001 and p = 0.024). The incidence of post-ERCP adverse events was: PEP in 2.7 % (28 procedures), bleeding in 0.8 % (8 procedures), cholangitis in 0.7 % (7 procedures) and perforation in 0.5 % (5 procedures). Higher risk for PEP was identified in patients with native papilla when compared with non-native papilla (pancreatitis rate of 3.6 % and 0.6 %, respectively, p=0.005). In patients with native papilla, ≥2 unintentional pancreatic duct cannulations (OR 2.371, CI: 1.003–5.605 (95 %), p=0.049) was the only predictive factor associated with PEP.

Tab. 1 Logistic Regression–Predictive factors for post-ERCP pancreatitis in patients with native papilla

	OR (%)	95 % CI (%)	p value
Time until biliary cannulation > 10 minutes	1.395	0.551 – 3.528	0.482
Number of times pancreatic duct was unintentionally cannulated ≥ 2	2.371	1.003 – 5.605	0.049
Unintentionally injection of contrast in the pancreatic duct	2.5	0.91 – 6.868	0.076
Difficult biliary cannulation group (Defined according to ESGE guidelines as: >5 contacts with the papilla or >5 minutes of cannulation attempts or >1 unintended pancreatic duct cannulation/opacification)	2.188	0.908 – 5.273	0.081

Conclusions Choledocholithiasis is associated with a higher cannulation rate while malignant stenosis and acute gallstone pancreatitis are associated with a lower cannulation rate. Patients with native papilla have a significantly higher risk of PEP. In this group of patients, the only factor associated with PEP was two or more unintentional pancreatic duct cannulations.

Citation: de Sousa Damião F, Noronha Ferreira C, Moura M et al. OP67 QUALITY IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: ADVERSE EVENTS AND THEIR PREDICTIVE FACTORS. Endoscopy 2021; 53: S28.

Publication History

Article published online:
19 March 2021