Elsevier

Gastrointestinal Endoscopy

Volume 60, Issue 5, November 2004, Pages 721-731
Gastrointestinal Endoscopy

Original Article
Complications of ERCP: a prospective study

https://doi.org/10.1016/S0016-5107(04)02169-8Get rights and content

Background

Studies of ERCP-related morbidity seldom include a sufficient patient follow-up. The aim of this study was to characterize and to evaluate the frequency of complications, cardiopulmonary untoward events in particular.

Methods

All patients undergoing ERCP during a 2-year period were included in this prospective study. Complications were assessed at the time of ERCP and by postal/telephone contact at 30-days after the procedure.

Results

A total of 1177 ERCPs were included in the analysis, of which 56.2% were therapeutic. The 30-day complication rate was 15.9%; the procedure-related mortality rate was 1.0%. Post-ERCP pancreatitis occurred in 3.8% of patients (3 deaths). Hemorrhage or perforation occurred with 0.9% and 1.1%, respectively, of the procedures (3 deaths). One perforation that resulted in the death of the patient occurred after placement of an endoprosthesis. Cholangitis occurred in relation to 5% of the ERCP procedures (3 deaths). Cardiorespiratory complications occurred in 2.3% (2 deaths). Dilated bile duct (p = 0.0001), placement of stent (p = 0.001), and use of more than 40 mg of hyoscine-N-butyl bromide (p < 0.05) were risk factors for complications by multivariate analysis. Risk of pancreatitis was increased with age under 40 years (p = 0.0078), placement of stent (p = 0.031), and a dilated bile duct (p = 0.036).

Conclusions

This prospective study confirms that the complication rate of ERCP including therapeutic procedures is high. Cardiopulmonary complications were not as common as expected, despite being the special focus of the study.

Section snippets

Patients and methods

An uncontrolled prospective study was conducted of complications occurring within 30 days of ERCP for all patients undergoing the procedure at a single university-affiliated hospital. The enrollment period was 2 years. All patients who underwent ERCP were eligible for inclusion; the only exclusion criterion was inability to perform ERCP because of an obstructed duodenum. During the time period of the study, approval of the protocol by the local ethics committee was not required.

A registration

Results

A total of 1177 consecutive patients scheduled for ERCP during a 2-year period (March 1998 to March 2000) entered the study (Table 1). No patient was categorized as ASA physical status IV. Of the ERCP procedures, 56.2% were therapeutic, 38.8% were diagnostic, and 5% were unsuccessful. When selective cannulation of the PD alone was intended, this was achieved in 72% of cases; when BD cannulation alone was the goal, it was achieved in 63% of cases; intended opacification of both ducts was

Discussion

The present study confirms that ERCP has a high complication rate, as noted on other studies,1., 2., 3., 4., 5., 6., 7., 8., 11. and underlines the need to minimize the number of diagnostic ERCP procedures. Although particular attention was given to cardiovascular morbidity and mortality in relation to ERCP, the present study did not confirm that more than 50% of the morbidity and mortality is cardiovascular in origin, as has been noted in other studies.10., 20., 21.

The present study evaluated

Acknowledgments

Special thanks to the nursing staff of the endoscopy unit of Hvidovre University Hospital for meticulous implementation of the registration form and to Michael Achiam, MD, for the follow-up of patients during a vacation period. Special thanks also to Drs. Linda Bardram and Ole Olsen (Department of Surgical Gastroenterology, Hvidovre University Hospital) for blinded expert evaluation of complications and their relation to ERCP. We thank Jacob Carstensen for help with the statistical analyses.

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