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

doi:10.1016/j.gie.2008.10.039

Gastrointestinal Endoscopy

Volume 70, Issue 1, July 2009, Pages 80-88

https://doi.org/10.1016/j.gie.2008.10.039 Get rights and content

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.

Section snippets

Procedures

The ERCP procedures were performed by a total of 8 expert endoscopists, almost always with a trainee “performing” at least part of the procedure. The GI TRAC endoscopy database (Akron Systems, Charleston, SC) contains information regarding all ERCP procedures performed at our institution since 1994. Data were collected and entered immediately after each case. The database contains 105 categories and more than 1000 potential variables, including demographics, clinical history and context, blood

Procedures

A total of 11,497 ERCP procedures were performed and documented over 12 years. The demographics, indications, and frequency of special interventions are outlined in Table 1.

Overall complications

There were a total of 462 complications (4.0%), 65% of which were pancreatitis in 304 cases (2.6%). The incidence of all complications and their severity grades are listed in Table 3. The multivariate analysis results for overall complications, pancreatitis, bleeding, and severe or fatal outcomes are shown in Table 4, Table 5

Discussion

This study of complications of ERCP and their correlates is the largest reported from a single center and reveals a number of clinical and procedural correlates for complications. The prevalence of overall complications was 4.0%, of which 72% were graded as mild (ie, requiring <3 days of hospital treatment). This prevalence is similar to 1 study⁸ but lower than many others, which ranged from 4.0% to 15.9%.2, 5, 6, 7, 8, 12, 13, 16, 17, 18, 19 The accuracy of the data and homogeneity in case

Acknowledgments

We are pleased to thank the many colleagues, trainees, and staff who helped to collect these data.

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: DISCLOSURE: The following author disclosed financial relationships relevant to this publication: P. B. Cotton: Consultant for Olympus America; serves on the advisory board for Apollo Endosurgery, Barosense and Alliance; has research grants from Wilson Cook Medical, and Boston Scientific/Microvasive. All other authors disclosed no financial relationships relevant to this publication.

: Presented at Digestive Disease Week, May 20-23, 2007, Washington, DC (Gastrointest Endosc 2007;65:AB212).

: See CME section; p. 141.

: If you want to chat with an author of this article, you may contact him at [email protected].

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

Background

Methods

Results

Conclusions

Section snippets

Procedures

Procedures

Overall complications

Discussion

Acknowledgments

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Lancet

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

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