RSS-Feed abonnieren
DOI: 10.1055/s-2007-966723
© Georg Thieme Verlag KG Stuttgart · New York
Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study
Publikationsverlauf
submitted 30 November 2006
accepted after revision 11 June 2007
Publikationsdatum:
17. August 2007 (online)
![](https://www.thieme-connect.de/media/endoscopy/200709/lookinside/thumbnails/10.1055-s-2007-966723-1.jpg)
Background and study aims: Analyses of endoscopic retrograde cholangiopancreatography (ERCP) complication are often constrained by the number of endpoints observed. This large-scale study aimed to identify the principal risk factors for ERCP complication.
Patients and methods: This was a prospective multicenter study of ERCP complications, based in five English regions. An exploratory univariable analysis of patients’ first recorded procedures identified potentially important patient- and procedure-related factors. For overall complications and pancreatitis, variables significant in univariable analysis were included in multiple regression.
Results: A total of 66 centers collected data on 5264 ERCPs, performed on 4561 patients. A therapeutic intervention was attempted in 3447/4561 (76 %) of patients as part of their first recorded ERCP. Following first recorded ERCP, 230 patients (5.0 %) suffered ≥ 1 complication: pancreatitis in 74 (1.6 %), cholangitis in 48 (1.0 %), hemorrhage in 40 (0.9 %), perforation in 20 (0.4 %), and miscellaneous in 54 (1.2 %). Significant factors from multiple regression were included in a multi-level analysis, which incorporated variables measured at the level of the endoscopist and hospital. For overall complication, risk factors (P value, odds ratio [OR], 95 % confidence interval [CI]) were: cannulation attempts > 1 (P = 0.094, OR 1.32, 95 % CI 0.95 - 1.83), precut (P = 0.033, OR 1.55, 95 % CI 1.04 - 2.32), and suspected sphincter of Oddi dysfunction (P = 0.121, OR 1.97, 95 % CI 0.84 - 4.64). For pancreatitis, risk factors (Pvalue, OR, and 95 % CI) were: cannulation attempts > 1 (P = 0.0001, OR 3.14, 95 % CI 1.74 - 5.67), female sex (P < 0.001, OR 2.22, 95 % CI 1.43 - 3.45), age (P < 0.002, OR 1.09 per 5 year decrease, 95 % CI 1.03 - 1.15), and performance in a district (as opposed to university) hospital (P = 0.034, OR 2.41, 95 % CI 1.08 - 5.41).
Conclusion: Careful patient selection combined with skilled cannulation minimizes complications. Higher-risk procedures should be performed in specialist centers.
References
- 1 Freeman M L. Adverse outcomes of ERCP. Gastrointest Endosc. 2002; 56 (6 Suppl) S273-S282
- 2 Masci E, Toti G, Mariani A. et al . Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001; 96 417-423
- 3 Loperfido S, Angelini G, Benedetti G. et al . Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998; 48 1-10
- 4 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996; 335 909-918
- 5 Freeman M L, DiSario J A, Nelson D B. et al . Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001; 54 425-434
- 6 Rabenstein T, Schneider H T, Bulling D. et al . Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment. Endoscopy. 2000; 32 10-19
- 7 Neoptolemos J P, Shaw D E, Carr-Locke D L. A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment. Ann Surg. 1989; 209 157-161
- 8 Mehta S N, Pavone E, Barkun J S. et al . Predictors of post-ERCP complications in patients with suspected choledocholithiasis. Endoscopy. 1998; 30 457-463
- 9 Tzovaras G, Shukla P, Kow L. et al . What are the risks of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography?. Aust N Z J Surg. 2000; 70 778-782
- 10 Motte S, Deviere J, Dumonceau J M. et al . Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991; 101 1374-1381
- 11 Boender J, Nix G A, de Ridder M A. et al . Endoscopic papillotomy for common bile duct stones: factors influencing the complication rate. Endoscopy. 1994; 26 209-216
- 12 Nelson D B, Freeman M L. Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol. 1994; 19 283-287
- 13 Maldonado M E, Brady P G, Mamel J J. et al . Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM). Am J Gastroenterol. 1999; 94 387-390
- 14 Christensen M, Matzen P, Schulze S. et al . Complications of ERCP: a prospective study. Gastrointest Endosc. 2004; 60 721-731
- 15 Cheng C L, Sherman S, Watkins J L. et al . Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006; 101 139-147
- 16 Aronson N, Flamm C R, Bohn R L. et al . Evidence-based assessment: patient, procedure, or operator factors associated with ERCP complications. Gastrointest Endosc. 2002; 56 (6 Suppl) S294-302
- 17 Williams E J, Taylor S, Fairclough P. et al . Are we meeting the standards set for endoscopy? Results of a large scale prospective survey of ERCP practice. Gut. 2007; 56 821-829
- 18 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 19 Concato J, Feinstein A R, Holford T R. The risk of determining risk with multivariable models. Ann Intern Med. 1993; 118 201-210
- 20 Hosmer D, Lemeshow S. Applied logistic regression. 2nd edn. New York; John Wiley and Sons Inc 2000
-
21 American Society of Anesthesiology .http://Available from URL: http://www.asahq.org/clinical/physicalstatus.htm (accessed 9 March 2006)
- 22 Masci E, Mariani A, Curioni S. et al . Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy. 2003; 35 830-834
- 23 Huibregtse K. Complications of endoscopic sphincterotomy and their prevention. N Engl J Med. 1996; 335 961-963
- 24 Binmoeller K F, Seifert H, Gerke H. et al . Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc. 1996; 44 689-695
- 25 Foutch P G. A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy. Gastrointest Endosc. 1995; 41 25-32
- 26 Kasmin F E, Cohen D, Batra S. et al . Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications. Gastrointest Endosc. 1996; 44 48-53
- 27 Varadarajulu S, Kilgore M L, Wilcox C M. et al . Relationship among hospital ERCP volume, length of stay, and technical outcomes. Gastrointest Endosc. 2006; 64 338-347
- 28 Perini R F, Sadurski R, Cotton P B. et al . Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference?. Gastrointest Endosc. 2005; 61 53-57
- 29 Singh P, Das A, Isenberg G. et al . Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004; 60 544-550
M. Lombard, MD
Department of Gastroenterology, Royal Liverpool University Hospital
Prescot Street
Liverpool, L7 8XP
UK
Fax: +44-151-7065832
eMail: martin.lombard@rlbuht.nhs.uk