Study On The Risk Factors Causing ERCP Complications

Background and Objective:The endoscopic retrograde cholangiopancreatography (ERCP) has already been extensively utilized in diagnosis and treatment of biliary and pancreatic diseases. It has been used in many large hospitals and proved to be a safe and effective technique. With the extensive application of ERCP and wide usage of endoscopic papillosphincterotomy (EST), the incidence of postoperative complications increased. How to prevent and reduce the incidence of complications was the key to safely and effectively perform ERCP. The aim of the study is to investigate the risk factors causing the complications of ERCP in order to reduce the incidence of ERCP complications.Materials and Methods:Data were collected from patients who were conducted with diagnostic and/or therapeutic ERCP during August 2005 and June 2007 in Digestive Endoscopy Center of the Chinese PLA General Hospital. ERCP complications were recorded and analyzed by univariate analysis.Results:The success rate of diagnostic and/or therapeutic ERCP were 96.8%(836/864) in 864 patients. The main factors to affect the success rate of ERCP:Duodenal papilla was blocked by tumors and guide wire could not enter it. Tumors, ulcers or other reasons caused stenosis and obstruction of bowel. Endoscope could not enter the descending part of duodenum. Complications occured in 105 cases (12.2%): post-ERCP pancreatitis (PEP) 49 cases (5.7%), cholangitis 37 cases (4.3%), bleeding 15 cases (1.7%) and perforation 4 cases (0.5%). The univariate analysis showed that the main risk factors of PEP are long cannulation time more than 60 minutes(P=0.022), the pancreatic duct imaging (P=0.009), sphincter of oddi dysfunction (SOD) (P=0.000) and normal serum bilirubin (P=0.045). There was no significant difference between the following:gender(P=0.056),malignancies (P=0.899),history of biliary stones (P=0.288),duodenal diverticulum (P=0.370) and chronic pancreatitis (P=0.819). The risk factors of acute cholangitis are malignancies (P=0.001), bile duct stones (P=0.006),Hilar bile duct obstruction (P=0.000) and biliary tract therapeutic ERCP (P=0.012).There was no significant difference between the following:gender (P=0.334),history of SOD(P=0.667),Low level biliary obstruction (P=0.816) and pancreatic therapeutic ERCP (P=0.433)Conclusions:1.The main factors to affect the success of ERCP is related to the patients' intrinsic factors and the doctors'techniques.2.the main risk factors of PEP are long cannulation time more than 60 minutes, the pancreatic duct imaging, sphincter of oddi dysfunction and normal serum bilirubin.3.The risk factors of acute cholangitis are malignancies, bile duct stones, Hilar bile duct obstruction and biliary tract therapeutic ERCP.4.ERCP is a safe and effective technique in diagnosis and treatment of biliary and pancreatic diseases.