Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study

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To investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia.


Consecutive ERCP procedures were studied at 14 centers in China from May 2006 to April 2007. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors.


A total of 3,178 procedures were performed on 2,691 patients. Overall, complications developed in 213 (7.92%) patients, pancreatitis in 116 (4.31%), and asymptomatic hyperamylasemia in 396 (14.72%). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95% confidence interval (CI): 1.14-2.02,P=0.004), periampullary diverticulum (OR: 2.02, 95% CI: 1.49-2.73,P<0.001), cannulation time >10 min (OR: 1.51, 95% CI: 1.08-2.10,P=0.016), ≥1 pancreatic deep wire pass (OR: 1.80, 95% CI: 1.33-2.42,P<0.001), and needle-knife precut (OR: 2.70, 95% CI: 1.42-5.14,P=0.002) were risk factors for overall complications. Female gender (OR: 1.84, 95% CI: 1.25-2.70,P=0.002), age ≤60 year (OR: 1.59, 95% CI: 1.06-2.39,P=0.025), cannulation time >10 min (OR: 1.76, 95% CI: 1.13-2.74,P=0.012), ≥1 pancreatic deep wire pass (OR: 2.77, 95% CI: 1.79-4.30,P<0.001), and needle-knife precut (OR: 4.34, 95% CI: 1.92-9.79,P<0.001) were risk factors for pancreatitis. Cannulation time >10 min (OR: 1.96, 95% CI: 1.52-2.54,P<0.001), ≥1 pancreatic deep wire pass (OR: 2.24, 95% CI: 1.74-2.89,P<0.001), needle-knife precut (OR: 2.34, 95% CI: 1.32-4.14,P=0.004), and major papilla pancreatic sphincterotomy (OR: 1.71, 95% CI: 1.23-2.37,P=0.001) were risk factors for asymptomatic hyperamylasemia.


Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.

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