Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years

• Published in: Gastrointestinal endoscopy Vol. 70; no. 1; pp. 80 - 88
• Main Authors: Cotton, Peter B., MD, FRCP, FRCS, Garrow, Donald A., MD, MS, Gallagher, Joseph, MD, Romagnuolo, Joseph, MD, FRCPC, MScEpid, FASGE
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.07.2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Digestive system; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevalence; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors; Survival Rate - trends; Time Factors; United States - epidemiology; Young Adult; United States; SOD; American Society of Anesthesiologists; OR; odds ratio; sphincter of Oddi dysfunction; ASA; Cholangiopancreatography; Complication; Endoscopy; Radiodiagnosis; Risk factor; Gastroenterology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.10.039

Background Complications of ERCP are an important concern. We sought to determine predictors of post-ERCP complications at our institution. Methods GI TRAC is a comprehensive data set of patients who underwent ERCP at our institution from 1994 through 2006. Logistic regression models were used to evaluate 4 categories of complications: (1) overall complications, (2) pancreatitis, (3) bleeding, and (4) severe or fatal complications. Independent predictors of complications were determined with multivariable logistic regression. Results A total of 11,497 ERCP procedures were analyzed. There were 462 complications (4.0%), 42 of which were severe (0.36%) and 7 were fatal (0.06%). Specific complications of pancreatitis (2.6%) and bleeding (0.3%) were identified. Overall complications were statistically more likely among individuals with suspected sphincter of Oddi dysfunction (SOD) (odds ratio [OR] 1.91) and after a biliary sphincterotomy (OR 1.32). Subjects with a history of acute or chronic pancreatitis (OR 0.78) or who received a temporary small-caliber pancreatic stent (OR 0.69) had fewer complications. Post-ERCP pancreatitis was more likely to occur after a pancreatogram via the major papilla (OR 1.70) or minor papilla (OR 1.54) and among subjects with suspected SOD with stent placement (OR 1.45) or without stent placement (OR 1.84). Individuals undergoing biliary-stent exchange had less-frequent pancreatitis (OR 0.38). Biliary sphincterotomy was associated with bleeding (OR 4.71). Severe or fatal complications were associated with severe (OR 2.38) and incapacitating (OR 7.65) systemic disease, obesity (OR 5.18), known or suspected bile-duct stones (OR 4.08), pancreatic manometry (OR 3.57), and complex (grade 3) procedures (OR 2.86). Conclusions This study characterizes a large series of ERCP procedures from a single institution and outlines the incidence and predictors of complications.