Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification

Young Koog Cheon, Kwang Bum Cho, James L. Watkins, Lee McHenry, Evan Fogel, Stuart Sherman, Glen Lehman

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101 Citations (Scopus)

Abstract

Background: Pancreatitis is the most common complication of diagnostic and therapeutic ERCP. Almost certainly, the etiology of this pancreatitis is multifactorial. Objective: The primary objective of this study was to evaluate the relationship between the extent of pancreatic ductal opacification and the frequency of pancreatitis. Design: Retrospective study. Setting: The ERCP database at our institution was searched for prospectively collected data from 1994 to 2005. Patients and Interventions: A total of 14,331 ERCPs were included in the analysis. Patients were divided into 4 groups according to the extent of pancreatic duct opacification: group 1, no attempted opacification or failed cannulation of the pancreatic duct (n = 6739); group 2, opacification of head only (n = 845); group 3, opacification of head and body (n = 2061); and group 4, opacification to the tail (n = 4685). The incidence and severity of pancreatitis was compared between and within each group. Results: The overall pancreatitis rate was 4.0%. There was a progressively higher frequency of pancreatitis with increased extent of opacification to the pancreatic ductal system (P < .001). The overall pancreatitis severity was mild in 2.9%, moderate in 0.8%, and severe in 0.3% of cases. There was a significant difference in pancreatitis severity between patients with pancreatogram (regardless of grade of filling) and patients without pancreatogram. (P < .001). However, there was no difference in the pancreatitis severity between groups 2 to 4 (patients with pancreatogram). Age (65 years vs >65 years), sex, and type of procedure performed (diagnostic and therapeutic) were not significantly different beyond the extent of pancreatic ductal opacification. Multivariate analysis showed that suspected sphincter of Oddi dysfunction with manometry and the extent of pancreatic duct opacification were independent predictors of post-ERCP pancreatitis. Conclusions: Less filling of the pancreatic ductal system was associated with less post-ERCP pancreatitis. Before performing endoscopic retrograde pancreatography, endoscopists should carefully evaluate whether any pancreatogram or what extent of pancreatogram is needed clinically. Greater use of noninvasive pancreatography and less use of endoscopic retrograde pancreatography should decrease post-ERCP pancreatitis.

Original languageEnglish
Pages (from-to)385-393
Number of pages9
JournalGastrointestinal Endoscopy
Volume65
Issue number3
DOIs
StatePublished - Mar 2007

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Pancreatic Ducts
Sphincter of Oddi Dysfunction
Head
Manometry
Catheterization
Multivariate Analysis
Retrospective Studies
Databases
Incidence
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

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Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. / Cheon, Young Koog; Cho, Kwang Bum; Watkins, James L.; McHenry, Lee; Fogel, Evan; Sherman, Stuart; Lehman, Glen.

In: Gastrointestinal Endoscopy, Vol. 65, No. 3, 03.2007, p. 385-393.

Research output: Contribution to journalArticle

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abstract = "Background: Pancreatitis is the most common complication of diagnostic and therapeutic ERCP. Almost certainly, the etiology of this pancreatitis is multifactorial. Objective: The primary objective of this study was to evaluate the relationship between the extent of pancreatic ductal opacification and the frequency of pancreatitis. Design: Retrospective study. Setting: The ERCP database at our institution was searched for prospectively collected data from 1994 to 2005. Patients and Interventions: A total of 14,331 ERCPs were included in the analysis. Patients were divided into 4 groups according to the extent of pancreatic duct opacification: group 1, no attempted opacification or failed cannulation of the pancreatic duct (n = 6739); group 2, opacification of head only (n = 845); group 3, opacification of head and body (n = 2061); and group 4, opacification to the tail (n = 4685). The incidence and severity of pancreatitis was compared between and within each group. Results: The overall pancreatitis rate was 4.0{\%}. There was a progressively higher frequency of pancreatitis with increased extent of opacification to the pancreatic ductal system (P < .001). The overall pancreatitis severity was mild in 2.9{\%}, moderate in 0.8{\%}, and severe in 0.3{\%} of cases. There was a significant difference in pancreatitis severity between patients with pancreatogram (regardless of grade of filling) and patients without pancreatogram. (P < .001). However, there was no difference in the pancreatitis severity between groups 2 to 4 (patients with pancreatogram). Age (65 years vs >65 years), sex, and type of procedure performed (diagnostic and therapeutic) were not significantly different beyond the extent of pancreatic ductal opacification. Multivariate analysis showed that suspected sphincter of Oddi dysfunction with manometry and the extent of pancreatic duct opacification were independent predictors of post-ERCP pancreatitis. Conclusions: Less filling of the pancreatic ductal system was associated with less post-ERCP pancreatitis. Before performing endoscopic retrograde pancreatography, endoscopists should carefully evaluate whether any pancreatogram or what extent of pancreatogram is needed clinically. Greater use of noninvasive pancreatography and less use of endoscopic retrograde pancreatography should decrease post-ERCP pancreatitis.",
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AU - Cheon, Young Koog

AU - Cho, Kwang Bum

AU - Watkins, James L.

AU - McHenry, Lee

AU - Fogel, Evan

AU - Sherman, Stuart

AU - Lehman, Glen

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N2 - Background: Pancreatitis is the most common complication of diagnostic and therapeutic ERCP. Almost certainly, the etiology of this pancreatitis is multifactorial. Objective: The primary objective of this study was to evaluate the relationship between the extent of pancreatic ductal opacification and the frequency of pancreatitis. Design: Retrospective study. Setting: The ERCP database at our institution was searched for prospectively collected data from 1994 to 2005. Patients and Interventions: A total of 14,331 ERCPs were included in the analysis. Patients were divided into 4 groups according to the extent of pancreatic duct opacification: group 1, no attempted opacification or failed cannulation of the pancreatic duct (n = 6739); group 2, opacification of head only (n = 845); group 3, opacification of head and body (n = 2061); and group 4, opacification to the tail (n = 4685). The incidence and severity of pancreatitis was compared between and within each group. Results: The overall pancreatitis rate was 4.0%. There was a progressively higher frequency of pancreatitis with increased extent of opacification to the pancreatic ductal system (P < .001). The overall pancreatitis severity was mild in 2.9%, moderate in 0.8%, and severe in 0.3% of cases. There was a significant difference in pancreatitis severity between patients with pancreatogram (regardless of grade of filling) and patients without pancreatogram. (P < .001). However, there was no difference in the pancreatitis severity between groups 2 to 4 (patients with pancreatogram). Age (65 years vs >65 years), sex, and type of procedure performed (diagnostic and therapeutic) were not significantly different beyond the extent of pancreatic ductal opacification. Multivariate analysis showed that suspected sphincter of Oddi dysfunction with manometry and the extent of pancreatic duct opacification were independent predictors of post-ERCP pancreatitis. Conclusions: Less filling of the pancreatic ductal system was associated with less post-ERCP pancreatitis. Before performing endoscopic retrograde pancreatography, endoscopists should carefully evaluate whether any pancreatogram or what extent of pancreatogram is needed clinically. Greater use of noninvasive pancreatography and less use of endoscopic retrograde pancreatography should decrease post-ERCP pancreatitis.

AB - Background: Pancreatitis is the most common complication of diagnostic and therapeutic ERCP. Almost certainly, the etiology of this pancreatitis is multifactorial. Objective: The primary objective of this study was to evaluate the relationship between the extent of pancreatic ductal opacification and the frequency of pancreatitis. Design: Retrospective study. Setting: The ERCP database at our institution was searched for prospectively collected data from 1994 to 2005. Patients and Interventions: A total of 14,331 ERCPs were included in the analysis. Patients were divided into 4 groups according to the extent of pancreatic duct opacification: group 1, no attempted opacification or failed cannulation of the pancreatic duct (n = 6739); group 2, opacification of head only (n = 845); group 3, opacification of head and body (n = 2061); and group 4, opacification to the tail (n = 4685). The incidence and severity of pancreatitis was compared between and within each group. Results: The overall pancreatitis rate was 4.0%. There was a progressively higher frequency of pancreatitis with increased extent of opacification to the pancreatic ductal system (P < .001). The overall pancreatitis severity was mild in 2.9%, moderate in 0.8%, and severe in 0.3% of cases. There was a significant difference in pancreatitis severity between patients with pancreatogram (regardless of grade of filling) and patients without pancreatogram. (P < .001). However, there was no difference in the pancreatitis severity between groups 2 to 4 (patients with pancreatogram). Age (65 years vs >65 years), sex, and type of procedure performed (diagnostic and therapeutic) were not significantly different beyond the extent of pancreatic ductal opacification. Multivariate analysis showed that suspected sphincter of Oddi dysfunction with manometry and the extent of pancreatic duct opacification were independent predictors of post-ERCP pancreatitis. Conclusions: Less filling of the pancreatic ductal system was associated with less post-ERCP pancreatitis. Before performing endoscopic retrograde pancreatography, endoscopists should carefully evaluate whether any pancreatogram or what extent of pancreatogram is needed clinically. Greater use of noninvasive pancreatography and less use of endoscopic retrograde pancreatography should decrease post-ERCP pancreatitis.

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