Risk factors for post-ERCP pancreatitis: A prospective multicenter study

Chi Liang Cheng, Stuart Sherman, James L. Watkins, Jeffrey Barnett, Martin Freeman, Joseph Geenen, Michael Ryan, Harrison Parker, James T. Frakes, Evan Fogel, William B. Silverman, Kulwinder S. Dua, Giuseppe Aliperti, Paul Yakshe, Michael Uzer, Whitney Jones, John Goff, Laura Lazzell-Pannell, Abdullah Rashdan, M'Hamed TemkitGlen Lehman

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Abstract

OBJECTIVES: Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. The aim of this study is to examine the potential patient- and procedure-related risk factors for post-ERCP pancreatitis in a prospective multicenter study. METHODS: A 160-variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-ERCP pancreatitis. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after discharge. Post-ERCP pancreatitis was diagnosed and its severity graded according to consensus criteria. RESULTS: Of the 1,115 patients enrolled, diagnostic ERCP with or without sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168 patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and severe in 11(1%). There was no difference in the incidence of pancreatitis or the frequency of investigated potential pancreatitis risk factors between the corticosteroid and placebo groups. By univariate analysis, the incidence of post-ERCP pancreatitis was significantly higher in 19 of 30 investigated variables. In the multivariate risk model, significant risk factors with adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8), suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr (OR: 1.6), ≥2 contrast injections into the pancreatic duct (OR: 1.5), and trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla sphincterotomy (either biliary or pancreatic) were not multivariate risk factors for post-ERCP pancreatitis. CONCLUSION: This study emphasizes the role of patient factors (age, SOD, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, minor papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis.

Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume101
Issue number1
DOIs
StatePublished - Jan 2006

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Multicenter Studies
Prospective Studies
Odds Ratio
Sphincter of Oddi Dysfunction
Sphincter of Oddi
Manometry
Incidence
Adrenal Cortex Hormones
Injections
Pancreatic Ducts
Age Factors
Catheterization
Pancreas
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

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Risk factors for post-ERCP pancreatitis : A prospective multicenter study. / Cheng, Chi Liang; Sherman, Stuart; Watkins, James L.; Barnett, Jeffrey; Freeman, Martin; Geenen, Joseph; Ryan, Michael; Parker, Harrison; Frakes, James T.; Fogel, Evan; Silverman, William B.; Dua, Kulwinder S.; Aliperti, Giuseppe; Yakshe, Paul; Uzer, Michael; Jones, Whitney; Goff, John; Lazzell-Pannell, Laura; Rashdan, Abdullah; Temkit, M'Hamed; Lehman, Glen.

In: American Journal of Gastroenterology, Vol. 101, No. 1, 01.2006, p. 139-147.

Research output: Contribution to journalArticle

Cheng, CL, Sherman, S, Watkins, JL, Barnett, J, Freeman, M, Geenen, J, Ryan, M, Parker, H, Frakes, JT, Fogel, E, Silverman, WB, Dua, KS, Aliperti, G, Yakshe, P, Uzer, M, Jones, W, Goff, J, Lazzell-Pannell, L, Rashdan, A, Temkit, MH & Lehman, G 2006, 'Risk factors for post-ERCP pancreatitis: A prospective multicenter study', American Journal of Gastroenterology, vol. 101, no. 1, pp. 139-147. https://doi.org/10.1111/j.1572-0241.2006.00380.x
Cheng, Chi Liang ; Sherman, Stuart ; Watkins, James L. ; Barnett, Jeffrey ; Freeman, Martin ; Geenen, Joseph ; Ryan, Michael ; Parker, Harrison ; Frakes, James T. ; Fogel, Evan ; Silverman, William B. ; Dua, Kulwinder S. ; Aliperti, Giuseppe ; Yakshe, Paul ; Uzer, Michael ; Jones, Whitney ; Goff, John ; Lazzell-Pannell, Laura ; Rashdan, Abdullah ; Temkit, M'Hamed ; Lehman, Glen. / Risk factors for post-ERCP pancreatitis : A prospective multicenter study. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 1. pp. 139-147.
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T1 - Risk factors for post-ERCP pancreatitis

T2 - A prospective multicenter study

AU - Cheng, Chi Liang

AU - Sherman, Stuart

AU - Watkins, James L.

AU - Barnett, Jeffrey

AU - Freeman, Martin

AU - Geenen, Joseph

AU - Ryan, Michael

AU - Parker, Harrison

AU - Frakes, James T.

AU - Fogel, Evan

AU - Silverman, William B.

AU - Dua, Kulwinder S.

AU - Aliperti, Giuseppe

AU - Yakshe, Paul

AU - Uzer, Michael

AU - Jones, Whitney

AU - Goff, John

AU - Lazzell-Pannell, Laura

AU - Rashdan, Abdullah

AU - Temkit, M'Hamed

AU - Lehman, Glen

PY - 2006/1

Y1 - 2006/1

N2 - OBJECTIVES: Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. The aim of this study is to examine the potential patient- and procedure-related risk factors for post-ERCP pancreatitis in a prospective multicenter study. METHODS: A 160-variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-ERCP pancreatitis. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after discharge. Post-ERCP pancreatitis was diagnosed and its severity graded according to consensus criteria. RESULTS: Of the 1,115 patients enrolled, diagnostic ERCP with or without sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168 patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and severe in 11(1%). There was no difference in the incidence of pancreatitis or the frequency of investigated potential pancreatitis risk factors between the corticosteroid and placebo groups. By univariate analysis, the incidence of post-ERCP pancreatitis was significantly higher in 19 of 30 investigated variables. In the multivariate risk model, significant risk factors with adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8), suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr (OR: 1.6), ≥2 contrast injections into the pancreatic duct (OR: 1.5), and trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla sphincterotomy (either biliary or pancreatic) were not multivariate risk factors for post-ERCP pancreatitis. CONCLUSION: This study emphasizes the role of patient factors (age, SOD, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, minor papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis.

AB - OBJECTIVES: Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. The aim of this study is to examine the potential patient- and procedure-related risk factors for post-ERCP pancreatitis in a prospective multicenter study. METHODS: A 160-variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-ERCP pancreatitis. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after discharge. Post-ERCP pancreatitis was diagnosed and its severity graded according to consensus criteria. RESULTS: Of the 1,115 patients enrolled, diagnostic ERCP with or without sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168 patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and severe in 11(1%). There was no difference in the incidence of pancreatitis or the frequency of investigated potential pancreatitis risk factors between the corticosteroid and placebo groups. By univariate analysis, the incidence of post-ERCP pancreatitis was significantly higher in 19 of 30 investigated variables. In the multivariate risk model, significant risk factors with adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8), suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr (OR: 1.6), ≥2 contrast injections into the pancreatic duct (OR: 1.5), and trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla sphincterotomy (either biliary or pancreatic) were not multivariate risk factors for post-ERCP pancreatitis. CONCLUSION: This study emphasizes the role of patient factors (age, SOD, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, minor papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis.

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