Analysis Of The Risk Factors For Post-ERCP Cholangitis

Objective:This study was aim to define the incidence of post-ERCP cholangitis by a retrospective analysis of the patients who underwent ERCP in our hospital from January2009to May2011, and study the risk factors by the Logistic regression analysis. Meanwhile we want to find out possible preventive measures with the experience of Liwen professor, to reduce the incidence of post-ERCP cholangitis.Method:The retrospective analysis involved1204clinical cases which underwent ERCP in Naikai University Affiliated Hospital from January2009to May2011. Factors of patitent-related (age, gender, nature, periampullary diverticula, liver transplantation, the common bile duct diameter), procedure-related factors (EST, precut, endoscopic stone extraction, ENBD, ERBD, EPBD, ect.), ERCP technical difficulty, other factors (Endoscopic nasobiliary drainage, residual stones) were analyzed to predict post-ERCP cholangitis. First, univariate analysis including Independent-sample T test for measurement data, Chi-square test or Fisher exact test for binomial and nominal data, then multiplevariate Logistic regression analysis was used in the factors which are statistically significant, in order to find out the risk factors of the post-ERCP cholangitis, and set up the Logistic regression model, SPSS19.0was used for the statistical analysis.Result:1204clinical cases were involved in the retrospective analysis. The success rate of ERCP was97.97%,27(2.23%) clinical cases developed cholangitis after ERCP, the overall complication rate was5.90%. In the univariate analysis, malignancy, a history of live transplantion, periampullary diverticula, Endoscopic retrograde biliary drainage were statistically significant (P<0.05), in the multiveariate analysis, periampullary diverticula was a potential protective factors, but it was not statistically significant.Manlignancy X1(OR=7.3795%CI=2.46-22.10), a history of live transplantion X2(OR=4.4795%CI=1.26-15.82), and Endoscopic retrograde biliary drainage X3(OR=2.8495%CI=1.19-6.82) were the risk factors of the post-ERCP cholangitis. The Logistic regression equation was P=1/[1+e(-251+2.00X1+1.50X2+1.05X3)]. The methods of reducing post-ERCP cholangitis include appropriate patient selection before the procedure, correct and skilled technique in the procedure, and the proper perioperative management.Conclusion:There are many factors related to post-ERCP cholangitis, Manlignancy, a history of live transplantion, and Endoscopic retrograde biliary drainage are the risk factors of the post-ERCP cholangitis, the core reason is incomplete or failed biliary drainage. Some preventive measures should be taken according to the risk factors and experience of Liwen professor:the patient should be adequately assessed before the procedure; in the patient who has biliary obstruction, contrast media shouid be injectde as less as possible or even not injected, and try to make sure every obstructive bile duct be adequate drainage; antibiotic prophylaxis should be considered before an ERCP in patients with known or suspected biliary obstruction in which there is a possibility that complete drainage may not be achieved at the ERCP; otherwise we shuould strive to develop the operation skills and improve the disinfection method, in this way, we can minimize the incidence of post-ERCP cholangitis.