Risk factors for ERCP-related complications: a prospective multicenter study.

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), > or =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 < or =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), > or =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), > or =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.