Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Evidence from 1786 Cases
Guo-zhen Li, Fan Wang, Jun Fang, Huo-long Zha, Qiu Zhao
(Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland))
Med Sci Monit 2018; 24:8544-8552
Postoperative pancreatitis is one of the most serious complications in endoscopic retrograde cholangiopancreatography (ERCP).
To detect potential risk factors for post-ERCP hyperamylasemia and pancreatitis.
MATERIAL AND METHODS: We reviewed 1786 ERCP procedures in Zhongnan Hospital of Wuhan University from January 2015 to April 2018. Clinical data were extracted, and the complications after ERCP procedures were re-evaluated. Single- and multiple-variable analyses were conducted to detect the potential risk factors.
RESULTS: We found that 1786 procedures were applied on 1707 patients; 64 patients (3.58%) developed pancreatitis, while asymptomatic hyperamylasemia occurred in 263 cases (14.73%). In multivariate analysis, pancreatic deep wire pass (odds ratio [OR]: 2.280, 95% CI [confidence interval]: 1.129–4.605, P=0.022), endoscopic metal biliary endoprosthesis (OR: 2.399, 95% CI: 1.120–5.138, P=0.024), operation after liver transplantation (OR: 3.057, 95% CI: 1.110–8.422, P=0.031), and fistulotomy (OR: 3.148, 95% CI: 1.036–9.561, P=0.043) were identified as independent risk factors for post-ERCP pancreatitis. Pancreatic deep wire pass (OR: 1.678, 95% CI: 1.136–2.478, P=0.009), fistulotomy (OR: 2.553, 95% CI: 1.096–5.948, P=0.030), and younger age (OR: 0.990, 95% CI: 0.980–0.999, P=0.037) were identified as independent risk factors for hyperamylasemia.
CONCLUSIONS: To prevent post-ERCP pancreatitis, it is important to avoid high-risk procedures such as fistulotomy and pancreatic deep wire pass, especially in high-risk patients with liver transplantation. For patients with endoscopic metal biliary endoprosthesis, clinicians should pay more attention to the occurrence of post-ERCP pancreatitis.
Keywords: Cholangiopancreatography, Endoscopic Retrograde, Hyperamylasemia, Risk Factors