Risk factors for ERCP-related complications in patients with pancreas divisum: A retrospective study

Dana C. Moffatt, Gregory A. Coté, Haritha Avula, James L. Watkins, Lee McHenry, Stuart Sherman, Glen Lehman, Evan Fogel

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Abstract

Background: Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply. Objectives: To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP. Design: Retrospective cohort study. Setting: Tertiary care referral center. Patients: A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010. Main Outcome Measurements: Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP. Results: Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P < .01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98). Limitations: Retrospective analysis of prospectively collected data. Conclusions: Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.

Original languageEnglish
Pages (from-to)963-970
Number of pages8
JournalGastrointestinal Endoscopy
Volume73
Issue number5
DOIs
StatePublished - May 2011

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Endoscopic Retrograde Cholangiopancreatography
Pancreas
Retrospective Studies
Pancreatitis
Catheterization
Odds Ratio
Cholecystitis
Tertiary Care Centers
Hemorrhage
Sex Ratio
Chronic Pancreatitis

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Risk factors for ERCP-related complications in patients with pancreas divisum : A retrospective study. / Moffatt, Dana C.; Coté, Gregory A.; Avula, Haritha; Watkins, James L.; McHenry, Lee; Sherman, Stuart; Lehman, Glen; Fogel, Evan.

In: Gastrointestinal Endoscopy, Vol. 73, No. 5, 05.2011, p. 963-970.

Research output: Contribution to journalArticle

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title = "Risk factors for ERCP-related complications in patients with pancreas divisum: A retrospective study",
abstract = "Background: Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply. Objectives: To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP. Design: Retrospective cohort study. Setting: Tertiary care referral center. Patients: A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010. Main Outcome Measurements: Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP. Results: Early complications occurred after 7.8{\%} of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8{\%}, 0.7{\%}, 0.2{\%}, 0.1{\%}, and 0.1{\%} of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2{\%} of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2{\%} and 10.6{\%}, respectively (P < .01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95{\%} CI, 1.27-2.59), female sex (OR 1.94; 95{\%} CI, 1.25-3.01), previous PEP (OR 2.02; 95{\%} CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95{\%} CI, 3.25-17.07), and MiS (OR 1.62; 95{\%} CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95{\%} CI, 0.22-0.98). Limitations: Retrospective analysis of prospectively collected data. Conclusions: Among patients with PD, the rate of PEP is low (1.2{\%}) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2{\%} without and 10.6{\%} with). Traditional PEP risk factors apply to patients with PD.",
author = "Moffatt, {Dana C.} and Cot{\'e}, {Gregory A.} and Haritha Avula and Watkins, {James L.} and Lee McHenry and Stuart Sherman and Glen Lehman and Evan Fogel",
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T1 - Risk factors for ERCP-related complications in patients with pancreas divisum

T2 - A retrospective study

AU - Moffatt, Dana C.

AU - Coté, Gregory A.

AU - Avula, Haritha

AU - Watkins, James L.

AU - McHenry, Lee

AU - Sherman, Stuart

AU - Lehman, Glen

AU - Fogel, Evan

PY - 2011/5

Y1 - 2011/5

N2 - Background: Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply. Objectives: To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP. Design: Retrospective cohort study. Setting: Tertiary care referral center. Patients: A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010. Main Outcome Measurements: Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP. Results: Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P < .01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98). Limitations: Retrospective analysis of prospectively collected data. Conclusions: Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.

AB - Background: Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply. Objectives: To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP. Design: Retrospective cohort study. Setting: Tertiary care referral center. Patients: A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010. Main Outcome Measurements: Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP. Results: Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P < .01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98). Limitations: Retrospective analysis of prospectively collected data. Conclusions: Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.

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