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.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging