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Observational Study
. 2018 Jun 21;31(1):e1348.
doi: 10.1590/0102-672020180001e1348.

ERCP PERFORMANCE IN A TERTIARY BRAZILIAN CENTER: FOCUS ON NEW RISK FACTORS, COMPLICATIONS AND QUALITY INDICATORS

[Article in English, Portuguese]
Alana Costa Borges  1 , Paulo César de Almeida  2 , Stella Maria Torres Furlani  3 , Marcelo de Sousa Cury  4 , Douglas K Pleskow  5
Affiliations
Observational Study

ERCP PERFORMANCE IN A TERTIARY BRAZILIAN CENTER: FOCUS ON NEW RISK FACTORS, COMPLICATIONS AND QUALITY INDICATORS

[Article in English, Portuguese]
Alana Costa Borges et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: ERCP can lead to complications, which can be prevented by the recognition of risk factors.

Aim: To identify these risk factors, with quality evaluation.

Methods: Retrospective study in a Brazilian hospital in 194 patients, excluding surgically altered anatomy.

Results: 211 ERCPs were performed: 97.6% were therapeutic, 83.4% were started by trainees, with deep cannulation rate of 89.6%. Precut was needed in 16.6% of the ERCPs and classic sphincterotomy in 67.3%, with 75.4% of ductal clearance at single session and 8.0% of technical failure. Inacessible papillas ocurred in 2.5% of cases. There were 2.5% of late complications and 16% of early complications. Multivariate analysis identified six predictors for early complications: fistulotomy precut (OR=3.4, p=0.010), difficult cannulation (OR=21.5, p=0.002), attending's procedural time (OR=2.4, p=0.020), choledocholithiasis (adjusted OR=1.8, p=0.015), cannulation time (adjusted OR=3.2, p=0.018) and ERCP duration (adjusted OR=2.7, p=0.041).

Conclusion: Six risk factors for post-ERCP complications were identified. ERCP duration and cannulation time are suggested as new potential quality indicators.

Racional:: A CPRE está associada a complicações, que podem ser prevenidas pelo reconhecimento de fatores de risco.

Objetivo:: Identificar tais fatores em nosso meio, com avaliação de qualidade.

Métodos:: Estudo retrospectivo em 194 pacientes de um hospital brasileiro, excluindo-se anatomia cirurgicamente alterada.

Resultados:: Executaram-se 211 CPREs: 97.6% foram terapêuticas, 83.4% iniciadas pelos residentes, com 89.6% de taxa de canulação profunda. Pré-corte foi necessário em 16.6% das CPREs e papilotomia clássica em 67.3%, com esvaziamento ductal de 74.5% em única sessão e 8.0% de falha técnica. Papilas inacessíveis ocorreram em 2.5% dos casos. Houve complicações tardias (2.5%) e precoces (16%). Em análise multivariada, identificaram-se seis preditores para complicações precoces: fistulotomia (RC=3.4, p=0.010), canulação difícil (RC=21.5, p=0.002), tempo do preceptor no procedimento (RC=2.4, p=0.020), coledocolitíase (RC ajustada=1.8, p=0.015), tempo de canulação (RC ajustada=3.2, p=0.018) e duração da CPRE (RC ajustada=2.7, p=0.041).

Conclusão:: Identificaram-se seis fatores para complicações pós-CPRE, sugerindo-se duração da CPRE e tempo de canulação como novos potenciais indicadores de qualidade.

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Conflict of interest statement

Conflict of interest: none

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