Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis.

ABSTRACT

INTRODUCTION: The rate of complications after endoscopic sphincterotomy (ES) is about 10%, and early complications have been reported in 20% of patients considered unfit for surgery. AIM: To evaluate the early and long-term results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis. METHODOLOGY: All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were evaluated according to the American Society of Anesthesiology (ASA) criteria immediately before the operative procedure. Patients' ASA scores were as follows 49.4%, ASA 2; 29.9%, ASA 3; and 20.7%, ASA 4. RESULTS: The severity of acute pancreatitis was positively related to the anesthesiological grade (p = 0.014). Six patients (6.9%) had complications related to the endoscopic procedure. There was no significant relationship between the frequency of biliopancreatic complications during the follow-up (23/84, 27.4%) and the ASA grade. The frequency of cholecystectomy was inversely related to the ASA grade (p = 0.003). Seven patients (8.3%) died during the follow-up period multivariate analysis showed that the ASA grade (odds ratio [OR], 10.9; 95% confidence interval [CI], 1.2-96.6; p = 0.001) and age (OR, 1.1; 95% CI, 1.0-1.3; p = 0.037) were significantly related to survival. CONCLUSIONS: Endoscopic treatment is safe and effective in patients at high anesthesiological risk with acute pancreatitis, and survival is significantly related to the ASA grade.