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Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

American Journal of Gastroenterology volume 96, pages 417423 (2001) | Download Citation




Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study.


One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists.


Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (≤60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater.


The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.

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  1. 1.

    , , , et al. Endoscopic sphincterotomy complications and their management: an attempt to consensus. Gastrointest Endosc 1991;37:383–393.

  2. 2.

    , , A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Ann Surg 1989;209:157–161.

  3. 3.

    , , , et al. Complications of endoscopic sphincterotomy: A prospective series with enphasis on the increased risk associated with sphincter of Oddi dysfunction and non dilated bile duct. Gastroenterology 1991;101:1068–1075.

  4. 4.

    , , Endoscopic papillotomy for common bile duct stones influencing the complication rate. Endoscopy 1994;26:209–216.

  5. 5.

    , , , et al. ERCP induced acute pancreatitis. risk assessment based on diagnostic and specific therapeutic cases. Gastrointest Endosc 1996;43:376(abstract).

  6. 6.

    Complications of endoscopic sphincterotomy and their prevention. N Engl J Med 1996;335:961–962.

  7. 7.

    , , , et al. Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. N Engl J Med 1996;335:919–923.

  8. 8.

    , , , et al. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174:331–336.

  9. 9.

    , , , et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter of Oddi dysfunction. N Engl J Med 1989;320:82–87.

  10. 10.

    , , , et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909–918.

  11. 11.

    , , , et al. Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study. Gastrointest Endosc 1998;48:1–10.

  12. 12.

    Endoscopic treatment of biliary-tract disease. Lancet 1978;2:983–985.

  13. 13.

    , , Successes, failures, early complications and their management following endoscopic sphincterotomy: results in 394 consecutive patients from a single centre. Br J Surg 1985;72:215–219.

  14. 14.

    , , , et al. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet 1989;2:431–433.

  15. 15.

    ERCP: Present practice in a single region. Eur J Gastroenterol Hepatol 1996;8:145–148.

  16. 16.

    , , , et al. Prospective study of post-ERCP complications following diagnostic and therapeutic ERCP. Gastrointest Endosc 1996;43;401(abstract).

  17. 17.

    , , Precut papillotomy via fine-needle knife papillotome: A safe and effective technique. Gastrointest Endosc 1986;32:403–405.

  18. 18.

    , , , et al. Endoscopic sphincterotomy-induced pancreatitis: Increased risk associated with non dilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol 1994;89:327–333.

  19. 19.

    , , Risk factors for post-ERCP pancreatitis: A prospective multicenter studyAm J Gastroenterol 1997;92;16–39(abstract).

  20. 20.

    , , , et al. Choledocholithiasis. Evaluation of MR cholangiography for diagnosis. Radiology 1998;209:435–442.

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We thank W. Cook and Hoechst Marion Roussel for grants to support this study and Inphaser for statistical assistance.

Author information


  1. Gastroenterology and Endoscopic Unit, S. Raffaele Hospital, Milan, Italy

    • E Masci
    • , A Mariani
    • , S Curioni
    •  & P A Testoni
  2. Ospedale Civile, S.S. Giovanni, Milan, Italy

    • G Toti
  3. S.Gerardo Hospital, Monza, Milan, Italy

    • A Lomazzi
    •  & M Dinelli
  4. Valduce Hospital, Como, Italy

    • G Minoli
  5. European Oncology Institute, Milan, Italy

    • C Crosta
  6. Magenta Hospital, Milan, Italy

    • U Comin
  7. Abbiategrasso Hospital, Milan, Italy

    • A Fertitta
  8. Rho Hospital, Milan, Italy

    • A Prada
  9. S. Paolo Hospital, Milan, Italy

    • G Rubis Passoni


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Correspondence to E Masci.

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