Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

Abstract

Objective The aim of this study was to identify the incidence of and risk factors for post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after emergency endoscopic retrograde cholangiopancreatography (ERCP). Methods We performed a prospective multicenter observational study of 3914 patients who underwent ERCP. We compared the incidence of PEP after emergency and elective ERCP. Results A total of 3410 patients were enrolled in this study. Post-ERCP pancreatitis occurred in 44 of 800 patients (5.5%) and in 190 of 2418 patients (7.9%) in the emergency and elective groups, respectively. No significant difference was noted between the groups (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.52–1.03; P = 0.07). Multivariate analysis showed that the following factors increased the risk for PEP after emergency ERCP: contrast medium injection into the pancreatic duct (OR, 2.56; 95% CI, 1.30–5.03; P = 0.005), >4 cannulation attempts (OR, 5.72; 95% CI, 2.61–12.50; P < 0.001), and endoscopic papillary balloon dilatation (OR, 9.24; 95% CI, 2.13–40.10; P < 0.001). Conclusions No significant difference was noted in the incidence of PEP in patients after emergency and elective ERCP. We may prevent PEP even after emergency ERCP by avoiding contrast injection into the pancreatic duct, multiple cannulation attempts, and endoscopic papillary balloon dilatation.

Post-ERCP Pancreatitis Risk Factors: Is Post-Sphincterotomy Bleeding Another Risk Factor?

“…In the multicenter prospective study conducted by Nakai et al, 3410 patients underwent ERCP, of whom 800 underwent urgent and 2610 underwent elective procedures, and there was no significant difference in PEP incidence between the two groups. 12 The hypothesis that a history of ERCP would increase PEP risk by increasing secondary inflammation and making the second ERCP procedure more difficult was not supported by our study. In Freeman et al's study, the presence of a history of ERCP was not found to be significant.…”

“…In a study by Nakai et al, there was no significant difference found between patients who underwent emergency and elective ERCP. 12 Similarly, Matsubara et al also did not find a significant difference between the two groups. 19 Having a history of previous ERCP was found to increase the risk of PEP by 3.367 times (95% CI: 2.01-5.65), consistent with the results of the study by Freeman et al 10 The presence of cholangitis was associated with 5.050 times (95% CI: 1.497-17.036) increased risk of PEP, which aligns with the statistically significant findings in the study by Mutneja et al 17 The occurrence of PEP was significantly associated with the odds ratio (OR) of precut sphincterotomy, with a value of 3.564 (95% CI: 1.566-8.114), as observed in our study.…”

“…The findings of the study suggest that urgent ERCP procedures may be associated with a significantly higher risk of PEP, possibly due to the frequent use of this procedure in patients admitted with a diagnosis of cholangitis. In the multicenter prospective study conducted by Nakai et al, 3410 patients underwent ERCP, of whom 800 underwent urgent and 2610 underwent elective procedures, and there was no significant difference in PEP incidence between the two groups 12 …”

“…The multivariate analysis showed that emergency indication was significantly associated with an increased odds ratio (OR) for PEP, with a value of 14.110 (95% CI: 4.51-44.17). In a study by Nakai et al, there was no significant difference found between patients who underwent emergency and elective ERCP 12 . Similarly, Matsubara et al also did not find a significant difference between the two groups 19 …”

Risk factors for post‑retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones: A meta‑analysis

“…1). The basic characteristics of the included studies are listed in Table I (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). These studies were from China, Sweden, Japan, Korea, Greece, the USA and Germany, including case-control, prospective cohort and retrospective cohort studies.…”