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Multicenter Study
. 2022 Sep;34(6):1198-1204.
doi: 10.1111/den.14225. Epub 2022 Feb 4.

Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis

Koichi Fujita  1   2 , Shujiro Yazumi  3 , Hisakazu Matsumoto  4 , Masanori Asada  5 , Hiroko Nebiki  6 , Kazuya Matsumoto  7 , Toru Maruo  8 , Mamoru Takenaka  9 , Takeshi Tomoda  10 , Takumi Onoyama  7 , Akira Kurita  3 , Toshiharu Ueki  8 , Toshiro Katayama  11   12 , Takashi Kawamura  13 , Hirofumi Kawamoto  14 ; Bilio-pancreatic Study Group of West Japan
Affiliations
Multicenter Study

Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis

Koichi Fujita et al. Dig Endosc. 2022 Sep.

Abstract

Objectives: The reported incidence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) varies between 2.5% and 14%. The aim of this study was to evaluate the incidence and severity of AEs in biliary ERCP and to specify the risk factors and preventive measures for post-ERCP pancreatitis (PEP).

Methods: Patients with biliary disease with intact papilla were prospectively enrolled at 36 hospitals between April 2017 and March 2018. The primary outcomes were the incidence and severity of AEs.

Results: A total of 16,032 ERCP procedures were performed at the 36 hospitals during the study period and 3739 patients were enrolled. The overall incidence of AEs was 10.1% and ERCP-related mortality was 0.08%. PEP developed in 258 cases (6.9%), bleeding in 33 (0.9%), instrumental AEs in 17 (0.5%), infections in 37 (1.0%), cardiovascular AEs in eight (0.2%), pulmonary AEs in eight (0.2%), drug reaction AE in one (0.03%), pain in 15 (0.4%), and other AEs in 15 (0.4%). Multivariable analysis showed significant risk factors for PEP were: female of younger age, pancreatic guidewire-assisted biliary cannulation, temporary guidewire insertion into the pancreatic duct, total procedure time >60 min, and post-ERCP administration of non-steroidal anti-inflammatory drugs. Effective preventive measures were prophylactic pancreatic stenting (PPS) and epinephrine spraying onto the papilla.

Conclusions: In patients with intact papilla who underwent biliary ERCP, the incidence of AEs was 10.1% and the mortality was 0.08%. PPS and epinephrine spraying may prevent PEP.

Registration: This study was registered in the University Hospital Medical Information Network (UMIN000024820).

Keywords: cholangiopancreatography; endoscopic retrograde; pancreatitis.

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Conflict of interest statement

Authors declare no conflict of interest for this article.

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References

    1. Andriulli A, Loperfido S, Napolitano G et al. Incidence rates of post‐ERCP complications: A systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781–8. - PubMed
    1. Kochar B, Akshintala VS, Afghani E et al. Incidence, severity, and mortality of post‐ERCP pancreatitis: A systematic review by using randomized, controlled trials. Gastrointest Endosc 2015; 81: 143–9.e9. - PubMed
    1. Halttunen J, Meisner S, Aabakken L et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol 2014; 49: 752–8. - PubMed
    1. Testoni PA, Mariani A, Aabakken L et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657–83. - PubMed
    1. Freeman ML, Nelson DB, Sherman S et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909–18. - PubMed

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