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DOI: 10.1055/s-0040-1704458
ERCP IS MORE CHALLENGING IN CASES OF ACUTE BILIARY PANCREATITIS THAN IN ACUTE CHOLANGITIS - A COHORT ANALYSIS OF THE HUNGARIAN ERCP REGISTRY DATA
Publikationsverlauf
Publikationsdatum:
23. April 2020 (online)
Aims Endoscopic retrograde cholangiopancreatography (ERCP) is recommended in acute biliary pancreatitis (ABP) when cholangitis or common bile duct obstruction is present. The inflammation of the pancreas and the surrounding tissues might make the procedure more difficult, however this topic is not widely studied. We compared the outcomes and difficulty of ERCP in ABP and in acute cholangitis (AC) in prospectively collected data of 7 Hungarian tertiary centers.
Methods 240 ABP cases and 250 AC cases without ABP were included. Previous papillotomy, altered gastroduodenal anatomy, and cases with biliary stricture were excluded. The rate of biliary access, advanced cannulation method, adverse events, cannulation and fluoroscopy time, as well as subjective difficulty were evaluated.
Results No difference was found between biliary cannulation rates in the two groups (95.8% vs. 97.2%). Significantly more pancreatic guidewire manipulation (31.3% vs. 17.2%; p< 0.001) and prophylactic pancreatic stent use (19.6% vs. 4.8%; p< 0.001) were seen in the ABP than in AC group. Moreover, longer cannulation time in the ABP patients (248 vs. 185 s; p=0.043) and higher fluoroscopy times (91 vs. 107 s) in the AC group were measured. There was no difference between the rate of adverse events of the groups. No significant difference was found in subjective difficulty.
Conclusions ERCP in ABP cases is more challenging than in AC but does not affect the outcomes in our registry data. The higher frequency of difficult biliary cannulation in the ABP patients warrants the involvement of an experienced endoscopist.