Original Article
Clinical Endoscopy
Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification

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Background

Pancreatitis is the most common complication of diagnostic and therapeutic ERCP. Almost certainly, the etiology of this pancreatitis is multifactorial.

Objective

The primary objective of this study was to evaluate the relationship between the extent of pancreatic ductal opacification and the frequency of pancreatitis.

Design

Retrospective study.

Setting

The ERCP database at our institution was searched for prospectively collected data from 1994 to 2005.

Patients and Interventions

A total of 14,331 ERCPs were included in the analysis. Patients were divided into 4 groups according to the extent of pancreatic duct opacification: group 1, no attempted opacification or failed cannulation of the pancreatic duct (n = 6739); group 2, opacification of head only (n = 845); group 3, opacification of head and body (n = 2061); and group 4, opacification to the tail (n = 4685). The incidence and severity of pancreatitis was compared between and within each group.

Results

The overall pancreatitis rate was 4.0%. There was a progressively higher frequency of pancreatitis with increased extent of opacification to the pancreatic ductal system (P < .001). The overall pancreatitis severity was mild in 2.9%, moderate in 0.8%, and severe in 0.3% of cases. There was a significant difference in pancreatitis severity between patients with pancreatogram (regardless of grade of filling) and patients without pancreatogram. (P < .001). However, there was no difference in the pancreatitis severity between groups 2 to 4 (patients with pancreatogram). Age (65 years vs >65 years), sex, and type of procedure performed (diagnostic and therapeutic) were not significantly different beyond the extent of pancreatic ductal opacification. Multivariate analysis showed that suspected sphincter of Oddi dysfunction with manometry and the extent of pancreatic duct opacification were independent predictors of post-ERCP pancreatitis.

Conclusions

Less filling of the pancreatic ductal system was associated with less post-ERCP pancreatitis. Before performing endoscopic retrograde pancreatography, endoscopists should carefully evaluate whether any pancreatogram or what extent of pancreatogram is needed clinically. Greater use of noninvasive pancreatography and less use of endoscopic retrograde pancreatography should decrease post-ERCP pancreatitis.

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

References (22)

  • W.J. Cunliffe et al.

    A randomized prospective study comparing two contrast media in ERCP

    Endoscopy

    (1987)
  • Cited by (132)

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    See CME section; p. 464.

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