Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Abstract

AIMTo detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity.METHODSThis is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected.RESULTSThe study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP.CONCLUSIONPEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Evidence from 810 Cases.

“…The incidence of severe acute pancreatitis associated with diagnostic ERCP varies between 0.4 and 0.7% and this risk may increase up to 20-40% in high-risk patients. [15] Our study findings were consistent with previous literature data on PEP except for the incidence of severe acute pancreatitis of 0.12%, which was lower than that reported in the literature. Additional risk factors reported for acute pancreatitis include the absence of bile duct dilation, bile duct diameter of <1 cm, younger age, difficult cannulation and unintentional pancreatography.…”

No treatment for asymptomatic common bile ducts stones?

“…Seven factors were found significant in the univariate analysis: indication for ERCP (asymptomatic CBD stone disease), prolonged (> 10 min) cannulation time, technique for sphincterotomy, normal serum bilirubin level, biliary stent placement (no), pancreatic stent placement (yes), and antibiotics use (no). Interestingly and differently from others studies assessing the risk factors for post-ERCP pancreatitis 7 8 9 10 11 12 the presence of a non-dilated CBD was not considered in this multivariate analysis.…”

Endoscopic retrograde cholangiopancreatography in super-elderly patients: Is it safe?

“…Procedure time was defined as the time from insertion to age-related pathological changes in the pancreas. Pancreatic atrophy is commonly seen in elderly patients, and the pancreas may lose about 60 percent of its weight by 85 years of age (12). Bleeding was observed in 7.8% of our participants.…”