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

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Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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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