Analysis of the Risk Factors Associated with Endoscopic Sphincterotomy Techniques: Preliminary Results of a Prospective Study, with Emphasis on the Reduced Risk of Acute Pancreatitis with Low-Dose Anticoagulation Treatment

Abstract

Patients at risk for complications after endoscopic sphincterotomy can be identified by risk factor analysis. These data suggest the hypothesis that low-dose anticoagulation prior to endoscopic sphincterotomy reduces the risk of acute pancreatitis after sphincterotomy.

Prediction of Post-ERCP Pancreatitis

“…Rates of pancreatitis of 2% to 9% have been typical in unselected large prospective series (6)(7)(8)(9)(10)(11)(12)(13)(14). The subjects of the present study were consecutive patients who underwent diagnostic or therapeutic ERCP, and the incidence rate of pancreatitis was 4.2% in the subjects as a whole, 4.4 % in the diagnostic ERCP group, 4.0 %.…”

“…Pancreatitis remains the most common complication of ERCP, occurring after 1% to 30% of procedures (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and its reported incidence has varied with the thoroughness of follow-up, the definition used, factors related to patient susceptibility, case mix, types of maneuvers performed, and the endoscopist. Rates of pancreatitis of 2% to 9% have been typical in unselected large prospective series (6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…The mechanisms responsible for the development of post-ERCP pancreatitis are not fully understood, but they are thought to be multifactorial. A number of specific risk factors have been proposed as predictors of post-ERCP pancreatitis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and they include patient-, endoscopist-, and procedure-related factors. We therefore think that clear identification of risk factors is facilitated by analyzing the data for diagnostic ERCP and therapeutic ERCP separately.…”

ERCP Procedures in a Finnish Community Hospital: A Retrospective Analysis of 1207 Cases

“…The main complications are pancreatitis, haemorrhage, cholangitis and perforation of the CBD or duodenum (1, 2). Several studies, most from large academic centres have reported a low incidence of complications (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In InTRoDuCTIon Endoscopic retrograde cholangiopancreatography (ERCP) is used in the treatment of benign and malignant pancreatic and biliary diseases.…”

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…Knowledge and judgment, theoretically, is more likely to be acquired with increased experience. The risk of PEP increases when ERCP is performed by physicians with less experience 27,28 while the risk is decreased when ERCP is performed at referral centers. 22 Some of the procedure factors (see below) are considered attributable to techniques associated with less operator expertise.…”