Endoscopy
Subject Category: Endoscopy
Am J Gastroenterol 2009; 104:31–40; doi:10.1038/ajg.2008.5
Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study
Peng Wang MD1, Zhao-Shen Li MD1, Feng Liu MD1, Xu Ren MD2, Nong-Hua Lu MD3, Zhi-Ning Fan MD4, Qiang Huang MD5, Xiao Zhang MD6, Li-Ping He MD7, Wen-Sheng Sun MD8, Qiu Zhao MD9, Rui-Hua Shi MD10, Zi-Bin Tian MD11, Yan-Qing Li MD12, Wen Li MD13 and Fa-Chao Zhi MD14
- 1Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- 2Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, China
- 3Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- 4Digestive Endoscopy Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 5Digestive Endoscopy Center, Anhui Provincial Hospital, Hefei, China
- 6Department of Gastroenterology, The First People's Hospital of Hangzhou, Hangzhou, China
- 7Department of Gastroenterology, Fujian Provincial Hospital, Fuzhou, China
- 8Digestive Endoscopy Center, Shandong Communication Hospital, Jinan, China
- 9Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 10Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 11Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
- 12Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- 13Digestive Endoscopy Center, Tianjin Union Medical Center, Tianjin, China
- 14Department of Gastroenterology, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
Correspondence: Zhao-Shen Li, MD, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai 200433, China. E-mail: zhaoshenlismmu@gmail.com
Received 22 March 2007; Accepted 19 July 2008.
Abstract
OBJECTIVES:
To investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia.
METHODS:
Consecutive ERCP procedures were studied at 14 centers in China from May 2006 to April 2007. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors.
RESULTS:
A total of 3,178 procedures were performed on 2,691 patients. Overall, complications developed in 213 (7.92%) patients, pancreatitis in 116 (4.31%), and asymptomatic hyperamylasemia in 396 (14.72%). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95% confidence interval (CI): 1.14–2.02, P=0.004), periampullary diverticulum (OR: 2.02, 95% CI: 1.49–2.73, P<0.001), cannulation time >10 min (OR: 1.51, 95% CI: 1.08–2.10, P=0.016), 
1 pancreatic deep wire pass (OR: 1.80, 95% CI: 1.33–2.42, P<0.001), and needle-knife precut (OR: 2.70, 95% CI: 1.42–5.14, P=0.002) were risk factors for overall complications. Female gender (OR: 1.84, 95% CI: 1.25–2.70, P=0.002), age 
60 year (OR: 1.59, 95% CI: 1.06–2.39, P=0.025), cannulation time>10 min (OR: 1.76, 95% CI: 1.13–2.74, P=0.012), 1 pancreatic deep wire pass (OR: 2.77, 95% CI: 1.79–4.30, P<0.001), and needle-knife precut (OR: 4.34, 95% CI: 1.92–9.79, P<0.001) were risk factors for pancreatitis. Cannulation time>10 min (OR: 1.96, 95% CI: 1.52–2.54, P<0.001), 1 pancreatic deep wire pass (OR: 2.24, 95% CI: 1.74–2.89, P<0.001), needle-knife precut (OR: 2.34, 95% CI: 1.32–4.14, P=0.004), and major papilla pancreatic sphincterotomy (OR: 1.71, 95% CI: 1.23–2.37, P=0.001) were risk factors for asymptomatic hyperamylasemia.
CONCLUSIONS:
Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.
