Increased Risk of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography Following a Positive Intraoperative Cholangiogram: A Single-Center Experience

Abstract

Background/Aims: To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones. Methods: A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders. Results: Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05-21.89; p<0.05). Conclusions: In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort. Clin Endosc 2020 Jul 15.

Endoscopic retrograde cholangiopancreatography is not necessary in all patients with an abnormal intraoperative cholangiogram

“…9 Interestingly, a single-center casecontrol study showed a fivefold increased risk of post-ERCP pancreatitis following a positive IOC compared with an agesex matched cohort. 10 In our study, similar to previous studies, 5 post-ERCP pancreatitis was encountered in about 5% of cases, including two patients who had a negative ERCP.…”

“…Post‐ERCP pancreatitis is the most frequent among them, ranging between 2% and 15% of cases and accounts for substantial morbidity, occasional mortality, and increased healthcare expenditures 9 . Interestingly, a single‐center case–control study showed a fivefold increased risk of post‐ERCP pancreatitis following a positive IOC compared with an age–sex matched cohort 10 . In our study, similar to previous studies, 5 post‐ERCP pancreatitis was encountered in about 5% of cases, including two patients who had a negative ERCP.…”

Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment

“…Second, the severity of AEs could not be available. Third, the laboratory values or the use of contrast medium, which is considered to be established risk factors, information on ERCP volume, and the effect of preventive measures for PEP were not be evaluated 19 . Fourth, due to the nature of the database, even if various procedures were performed in an ERCP session, only one major procedure was recorded.…”

“…Third, the laboratory values or the use of contrast medium, which is considered to be established risk factors, information on ERCP volume, and the effect of preventive measures for PEP were not be evaluated. 19 Fourth, due to the nature of the database, even if various procedures were performed in an ERCP session, only one major procedure was recorded. Therefore, procedures such as multiple stenting and prophylactic pancreatic duct stenting were not properly analyzed.…”