Risk factors for post-ERCP pancreatitis

A prospective multicenter study

Stuart Sherman, Glen Lehman, D. Earle, J. Watkins, J. Barnett, J. Johanson, M. Freeman, J. Geenen, M. Ryan, H. Parker, E. Lazaridis, J. Flueckiger, W. Silverman, K. Dua, G. Aliperti, P. Yakshe, M. Uzer, W. Jones, J. Goff

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. This study examined the outcomes and influence of multiple potential risk factors for acute pancreatitis (AP) from diagnostic and therapeutic ERCP. METHODS: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-procedure pancreatitis. Data were collected at the time of the procedure, prior to and after discharge. Standardized criteria were used to diagnose and grade the severity of post-procedure pancreatitis (GI Endosc 1991;37:383). RESULTS: Of 935 patients undergoing ERCP, 139 (14.9%) developed pancreatitis. By univariate analysis, the incidence of AP was significantly higher with the following risk factors: age <60 yo [111/625 (17.8%) vs 28/310 (9.0%); p<.001], suspected sphincter of Oddi dysfunction (SOD) [76/309 (24.6%) vs 63/626 (10.1%); p<.001), difficulty of cannulation [36/393 (9.2%) vs 103/542 (19.0%); p<.001, easy vs moderate/difficult], pancreatic sphincterotomy [43/157 (27.4%) vs 96/778 (12.3%); p<.001[. The incidence of AP increased incrementally with each additional pancreatic duct (PD) injection (p=.003). The incidence of AP was not significantly higher with the following: prior pancreatitis, placebo (vs prednisone), body mass index, use of precut sphincterotomy, acinarization, CBD diameter, and the absence of chronic pancreatitis. In the multivariate risk model, the risk factors for AP were pancreatic sphincterotomy [Odds Ratio (O.R.), 2.31), number of PD injections (O.R. for each additional injection, 1.15), suspected SOD (O.R. 1.99). There was a significant association between the difficulty of cannulation and the number of pancreatic duct injections (p<.001). The mean number of PD injections for the easy cannulation group was 1.7 and for the moderate/difficult group, 2.68. In patients >60 yo, pancreatic (O.R. 10.12; p=.003) and biliary sphincterotomy (O.R. 4 44; p=.05) increased the risk of pancreatitis compared to diagnostic only procedures; this pattern was not observed in younger age groups. Patients >60 yo undergoing a diagnostic only procedure (O.R. 0.13; p=.008) or biliary sphincterotomy (O.R. 0.3;p=.004) were at lower risk for AP than patients <40 yo. CONCLUSIONS: The rate of post-ERCP pancreatitis is related to patient (age and SOD) and technical (number of PD injections, difficulty of cannulation, and pancreatic sphincterotomy) factors. For diagnostic only and biliary sphincterotomy procedures, older age played a protective role.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Multicenter Studies
Prospective Studies
Incidence
Catheterization
Adrenal Cortex Hormones
Therapeutics
Age Groups
Outcome Assessment (Health Care)
Databases
Injections

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Sherman, S., Lehman, G., Earle, D., Watkins, J., Barnett, J., Johanson, J., ... Goff, J. (1997). Risk factors for post-ERCP pancreatitis: A prospective multicenter study. Gastrointestinal Endoscopy, 45(4).

Risk factors for post-ERCP pancreatitis : A prospective multicenter study. / Sherman, Stuart; Lehman, Glen; Earle, D.; Watkins, J.; Barnett, J.; Johanson, J.; Freeman, M.; Geenen, J.; Ryan, M.; Parker, H.; Lazaridis, E.; Flueckiger, J.; Silverman, W.; Dua, K.; Aliperti, G.; Yakshe, P.; Uzer, M.; Jones, W.; Goff, J.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Sherman, S, Lehman, G, Earle, D, Watkins, J, Barnett, J, Johanson, J, Freeman, M, Geenen, J, Ryan, M, Parker, H, Lazaridis, E, Flueckiger, J, Silverman, W, Dua, K, Aliperti, G, Yakshe, P, Uzer, M, Jones, W & Goff, J 1997, 'Risk factors for post-ERCP pancreatitis: A prospective multicenter study', Gastrointestinal Endoscopy, vol. 45, no. 4.
Sherman, Stuart ; Lehman, Glen ; Earle, D. ; Watkins, J. ; Barnett, J. ; Johanson, J. ; Freeman, M. ; Geenen, J. ; Ryan, M. ; Parker, H. ; Lazaridis, E. ; Flueckiger, J. ; Silverman, W. ; Dua, K. ; Aliperti, G. ; Yakshe, P. ; Uzer, M. ; Jones, W. ; Goff, J. / Risk factors for post-ERCP pancreatitis : A prospective multicenter study. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
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abstract = "Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. This study examined the outcomes and influence of multiple potential risk factors for acute pancreatitis (AP) from diagnostic and therapeutic ERCP. METHODS: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-procedure pancreatitis. Data were collected at the time of the procedure, prior to and after discharge. Standardized criteria were used to diagnose and grade the severity of post-procedure pancreatitis (GI Endosc 1991;37:383). RESULTS: Of 935 patients undergoing ERCP, 139 (14.9{\%}) developed pancreatitis. By univariate analysis, the incidence of AP was significantly higher with the following risk factors: age <60 yo [111/625 (17.8{\%}) vs 28/310 (9.0{\%}); p<.001], suspected sphincter of Oddi dysfunction (SOD) [76/309 (24.6{\%}) vs 63/626 (10.1{\%}); p<.001), difficulty of cannulation [36/393 (9.2{\%}) vs 103/542 (19.0{\%}); p<.001, easy vs moderate/difficult], pancreatic sphincterotomy [43/157 (27.4{\%}) vs 96/778 (12.3{\%}); p<.001[. The incidence of AP increased incrementally with each additional pancreatic duct (PD) injection (p=.003). The incidence of AP was not significantly higher with the following: prior pancreatitis, placebo (vs prednisone), body mass index, use of precut sphincterotomy, acinarization, CBD diameter, and the absence of chronic pancreatitis. In the multivariate risk model, the risk factors for AP were pancreatic sphincterotomy [Odds Ratio (O.R.), 2.31), number of PD injections (O.R. for each additional injection, 1.15), suspected SOD (O.R. 1.99). There was a significant association between the difficulty of cannulation and the number of pancreatic duct injections (p<.001). The mean number of PD injections for the easy cannulation group was 1.7 and for the moderate/difficult group, 2.68. In patients >60 yo, pancreatic (O.R. 10.12; p=.003) and biliary sphincterotomy (O.R. 4 44; p=.05) increased the risk of pancreatitis compared to diagnostic only procedures; this pattern was not observed in younger age groups. Patients >60 yo undergoing a diagnostic only procedure (O.R. 0.13; p=.008) or biliary sphincterotomy (O.R. 0.3;p=.004) were at lower risk for AP than patients <40 yo. CONCLUSIONS: The rate of post-ERCP pancreatitis is related to patient (age and SOD) and technical (number of PD injections, difficulty of cannulation, and pancreatic sphincterotomy) factors. For diagnostic only and biliary sphincterotomy procedures, older age played a protective role.",
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TY - JOUR

T1 - Risk factors for post-ERCP pancreatitis

T2 - A prospective multicenter study

AU - Sherman, Stuart

AU - Lehman, Glen

AU - Earle, D.

AU - Watkins, J.

AU - Barnett, J.

AU - Johanson, J.

AU - Freeman, M.

AU - Geenen, J.

AU - Ryan, M.

AU - Parker, H.

AU - Lazaridis, E.

AU - Flueckiger, J.

AU - Silverman, W.

AU - Dua, K.

AU - Aliperti, G.

AU - Yakshe, P.

AU - Uzer, M.

AU - Jones, W.

AU - Goff, J.

PY - 1997

Y1 - 1997

N2 - Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. This study examined the outcomes and influence of multiple potential risk factors for acute pancreatitis (AP) from diagnostic and therapeutic ERCP. METHODS: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-procedure pancreatitis. Data were collected at the time of the procedure, prior to and after discharge. Standardized criteria were used to diagnose and grade the severity of post-procedure pancreatitis (GI Endosc 1991;37:383). RESULTS: Of 935 patients undergoing ERCP, 139 (14.9%) developed pancreatitis. By univariate analysis, the incidence of AP was significantly higher with the following risk factors: age <60 yo [111/625 (17.8%) vs 28/310 (9.0%); p<.001], suspected sphincter of Oddi dysfunction (SOD) [76/309 (24.6%) vs 63/626 (10.1%); p<.001), difficulty of cannulation [36/393 (9.2%) vs 103/542 (19.0%); p<.001, easy vs moderate/difficult], pancreatic sphincterotomy [43/157 (27.4%) vs 96/778 (12.3%); p<.001[. The incidence of AP increased incrementally with each additional pancreatic duct (PD) injection (p=.003). The incidence of AP was not significantly higher with the following: prior pancreatitis, placebo (vs prednisone), body mass index, use of precut sphincterotomy, acinarization, CBD diameter, and the absence of chronic pancreatitis. In the multivariate risk model, the risk factors for AP were pancreatic sphincterotomy [Odds Ratio (O.R.), 2.31), number of PD injections (O.R. for each additional injection, 1.15), suspected SOD (O.R. 1.99). There was a significant association between the difficulty of cannulation and the number of pancreatic duct injections (p<.001). The mean number of PD injections for the easy cannulation group was 1.7 and for the moderate/difficult group, 2.68. In patients >60 yo, pancreatic (O.R. 10.12; p=.003) and biliary sphincterotomy (O.R. 4 44; p=.05) increased the risk of pancreatitis compared to diagnostic only procedures; this pattern was not observed in younger age groups. Patients >60 yo undergoing a diagnostic only procedure (O.R. 0.13; p=.008) or biliary sphincterotomy (O.R. 0.3;p=.004) were at lower risk for AP than patients <40 yo. CONCLUSIONS: The rate of post-ERCP pancreatitis is related to patient (age and SOD) and technical (number of PD injections, difficulty of cannulation, and pancreatic sphincterotomy) factors. For diagnostic only and biliary sphincterotomy procedures, older age played a protective role.

AB - Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. This study examined the outcomes and influence of multiple potential risk factors for acute pancreatitis (AP) from diagnostic and therapeutic ERCP. METHODS: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-procedure pancreatitis. Data were collected at the time of the procedure, prior to and after discharge. Standardized criteria were used to diagnose and grade the severity of post-procedure pancreatitis (GI Endosc 1991;37:383). RESULTS: Of 935 patients undergoing ERCP, 139 (14.9%) developed pancreatitis. By univariate analysis, the incidence of AP was significantly higher with the following risk factors: age <60 yo [111/625 (17.8%) vs 28/310 (9.0%); p<.001], suspected sphincter of Oddi dysfunction (SOD) [76/309 (24.6%) vs 63/626 (10.1%); p<.001), difficulty of cannulation [36/393 (9.2%) vs 103/542 (19.0%); p<.001, easy vs moderate/difficult], pancreatic sphincterotomy [43/157 (27.4%) vs 96/778 (12.3%); p<.001[. The incidence of AP increased incrementally with each additional pancreatic duct (PD) injection (p=.003). The incidence of AP was not significantly higher with the following: prior pancreatitis, placebo (vs prednisone), body mass index, use of precut sphincterotomy, acinarization, CBD diameter, and the absence of chronic pancreatitis. In the multivariate risk model, the risk factors for AP were pancreatic sphincterotomy [Odds Ratio (O.R.), 2.31), number of PD injections (O.R. for each additional injection, 1.15), suspected SOD (O.R. 1.99). There was a significant association between the difficulty of cannulation and the number of pancreatic duct injections (p<.001). The mean number of PD injections for the easy cannulation group was 1.7 and for the moderate/difficult group, 2.68. In patients >60 yo, pancreatic (O.R. 10.12; p=.003) and biliary sphincterotomy (O.R. 4 44; p=.05) increased the risk of pancreatitis compared to diagnostic only procedures; this pattern was not observed in younger age groups. Patients >60 yo undergoing a diagnostic only procedure (O.R. 0.13; p=.008) or biliary sphincterotomy (O.R. 0.3;p=.004) were at lower risk for AP than patients <40 yo. CONCLUSIONS: The rate of post-ERCP pancreatitis is related to patient (age and SOD) and technical (number of PD injections, difficulty of cannulation, and pancreatic sphincterotomy) factors. For diagnostic only and biliary sphincterotomy procedures, older age played a protective role.

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