Risk factors for complications of ERCP in primary sclerosing cholangitis

Abstract

In patients with PSC the incidence of ERCP complications remained relatively low. The complication risk increased with the complexity of cannulation. In a patient with PSC in whom follow-up ERCP is planned, biliary sphincterotomy should be considered, as it may protect against PEP.

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…The largest series is the study by Ismail et al (71). In this retrospective review of 441 ERCP procedures over a three-year time period, primary cannulation success was 88.2%.…”

“…Several studies have evaluated the risk of complications in PSC patients undergoing ERCP (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74). ERCP carries an increased risk for complications in the context of PSC, especially pancreatitis, cholangitis and extravasation of contrast, although not all the studies were documented such an increased risk in PSC (69,74).…”

“…Although the quality of the evidence is low, risk factors increasing the risk for PEP are probably not different in PSC patients from the general population: female sex (odds ratio [OR] 2.6, P= 0.015) and a guide wire in the pancreatic duct (OR 8.2, P<0.01). Native papilla increases whereas previous sphincterotomy decreases the risk (71), suggesting that preemptive EPT might be warranted in PSC patients where repeat procedures might be anticipated. This has however yet to be proven.…”

Antibiotic prophylaxis for GI endoscopy

“…[31][32][33][34][35][36][37][38] Several studies have evaluated the role of antibiotic prophylaxis in preventing post-ERCP cholangitis. Although antibiotic prophylaxis has been shown to reduce the incidence of bacteremia associated with ERCP, 39,40 preprocedure antibiotic prophylaxis has not been shown to prevent cholangitis.…”

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

“…They are more commonly observed in subjects submitted to therapeutic ERC. Pancreatitis and cholangitis after ERC are reported to occur in, respectively, 5%-7% and 1% of the treated patients (109) . Before endoscopic treatment, it is usually recommended antibiotic prophylaxis to prevent ascending cholangitis (3) , that is more frequently seen in those subjects with cirrhosis, concurrent AIH and CD.…”