Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

Abstract

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

Adverse Outcomes of Endoscopic Retrograde Cholangiopancreatography at Gastroenterology and Hepatology Centers in Sulaymaniyah and Duhok City

“…This high difference might be attributed to our study Gastroenterology and Hepatology centre is a tertiary training centre that received the more complicated cases from different Iraqi hospitals last year in addition to factors related to the experience of Physicians and the health status of patients received. However, our study's post-ERCP complications rate is lower than that of Chen et al (24) study in China, which found that post-ERCP adverse events occurred in 31 (25.6%) patients. The ERCP is applied in highvolume and low-volume centres and by physicians of variable experiences in addition to the gradual training of physicians to acquire safe and effective ERCP (25) .…”

Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy

“…However, the two-stage procedure is complex and the success rate for one-stage TASR is low [ 14 , 15 ]. The technical success rate and clinical success rate were as high as 100% and 92.3%, respectively, in our evaluation of simplified single-session TASR and the incidence of adverse events was lower (15.4%) than that for ERCP (25.6%) [ 21 ]. We consider that the key to improving the technical success of simplified single-session TASR depends on a simplified process and the application of a 0.035-inch guide wire and co-axial cystotome.…”

Endoscopic Accessibility of the Biliary System in the Postoperative Situs

“…In addition, postoperative adhesions, strong curvature of the intestine, long afferent loops, individual surgical peculiarities, and different distances from defined marks impede the procedural success. The three mayor steps in successful ERCP in patients with altered anatomy include reaching the papilla or biliodigestive anastomosis, cannulation of the duct, and finally performing the planned intervention [6].…”