Original ArticleClinical EndoscopyFrequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification
Section snippets
Patients
Demographics, procedures, and follow-up data were prospectively collected at the time of the procedure and 24 to 72 hours after discharge. Records were entered into a computer database for subsequent processing and analysis. From January 1994 to September 2005, 14,431 procedures with no pancreatogram or with normal pancreatogram results were enrolled in this study. Patients with pancreas divisum, chronic pancreatitis with abnormal pancreatogram results, pancreatic cancer, and prior pancreatic
Frequency and severity of post-ERCP pancreatitis
Overall, post-ERCP pancreatitis occurred in 579 patients (4.0%). Any pancreatic duct opacification significantly increased the risk of pancreatitis (6.9%) compared with common bile duct injection alone (0.8%, P < .001). Failed ERCP occurred in 233 cases (3.5%) in group 1. The most common cause of failure was poor patient cooperation. No pancreatitis occurred in any of these failed procedures. Pancreatitis occurred more often in group 4 (8.6%) than in group 1 (0.8%), group 2 (3.6%), or group 3
Discussion
During ERCP and ES, the pancreas is subjected to many types of potential injury: mechanical, chemical, hydrostatic, enzymatic, microbiologic, allergic, and thermal.2 These factors may act independently or in concert to induce postprocedure pancreatitis. The contrast media used for pancreatography can also induce direct chemical irritation (eg, topical disinfectant agents on skin to include ethyl alcohol and topical mecurials) on pancreatic ductal surface. A recent meta-analysis showed that
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See CME section; p. 464.