A retrospective analysis of 500 ERCP procedures: outcomes, adverse events, and risk factors over two years

Year 2024, Volume: 5 Issue: 6, 309 - 313, 23.12.2024

Yunus Halil Polat , Ahmet Yozgat

Abstract

Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure for both the diagnosis and management of biliary and pancreatic ductal diseases. While it has been largely replaced by non-invasive imaging techniques for diagnostic purposes, ERCP remains the gold standard for therapeutic interventions. This study aims to retrospectively analyze the outcomes, adverse events, and success rates of ERCP procedures performed on 500 patients over two years.
Methods: A retrospective review of 500 ERCP procedures performed at a single center over 24 months was conducted. Patient demographics, indications for ERCP, procedural outcomes, and adverse event rates were collected and analyzed. Success rates for therapeutic interventions, as well as risk factors for post-procedural adverse events, were identified.
Results: The study revealed that 448 (89.6%) of ERCP procedures were successful in achieving the primary therapeutic goal (e.g., stone extraction, stent placement). Adverse events occurred in 93 (18.6%) of cases, with post-ERCP pancreatitis being the most common adverse event (n: 73, 14.6%). Risk factors associated with adverse events included previous cholecystectomy (p<0.001), difficult cannulation (p<0.001), and prolonged procedure time (p:0.003).
Conclusion: ERCP remains a highly effective treatment tool for treating biliary and pancreatic diseases, although it carries the risk of many adverse events. The identification of key risk factors may help to minimize the incidence of adverse events and improve patient outcomes. The data collected in this study provide valuable insight into the current practice of ERCP and the role it plays in modern gastroenterology.

Keywords

ERCP, biliary diseases, therapeutic endoscopy, post-ERCP pancreatitis, adverse event rates, retrospective study

Ethical Statement

The study was conducted with the permission of the Ankara Training and Research Hospital Clinical Research Ethics Committee (Date: 08.05.2024, Decision No: 107/2024).

Supporting Institution

The authors declared that this study has received no financial support.

Retrospektif 500 ERCP Prosedürü Analizi: İki Yıl Boyunca Sonuçlar, Advers Olaylar ve Risk Faktörleri

Abstract

Amaç: Endoskopik Retrograd Kolanjiyopankreatografi (ERCP), biliyer ve pankreatik duktal hastalıkların hem tanısı hem de tedavisi için yaygın olarak kullanılan bir prosedürdür. Tanı amaçlı olarak yerini büyük ölçüde non-invaziv görüntüleme tekniklerine bırakmış olsa da, ERCP terapötik girişimler için altın standart olmaya devam etmektedir. Bu çalışmanın amacı, iki yıl boyunca 500 hastaya uygulanan ERCP prosedürlerinin sonuçlarını, advers olaylarını ve başarı oranlarını retrospektif olarak analiz etmektir.
Yöntemler: Tek bir merkezde 24 ay boyunca gerçekleştirilen 500 ERCP prosedürünün retrospektif bir incelemesi yapıldı. Hasta demografisi, ERCP endikasyonları, prosedür sonuçları ve advers olay oranları toplandı ve analiz edildi. Terapötik müdahaleler için başarı oranlarının yanı sıra işlem sonrası advers olaylar için risk faktörleri belirlendi.
Sonuçlar: Çalışma, ERCP prosedürlerinin 448'inin (%89,6) birincil terapötik hedefe (örn. taş çıkarma, stent yerleştirme) ulaşmada başarılı olduğunu ortaya koydu. Olguların 93'ünde (%18,6) advers olay meydana gelmiş olup, ERCP sonrası pankreatit en yaygın advers olaydır (n: 73, %14,6). Advers olaylarla ilişkili risk faktörleri arasında önceki kolesistektomi (p<0.001), zor kanülasyon (p<0.001) ve uzamış işlem süresi (p:0.003) yer almıştır.
Tartışma: ERCP, birçok advers olay riski taşımasına rağmen, biliyer ve pankreatik hastalıkların tedavisinde oldukça etkili bir tedavi aracı olmaya devam etmektedir. Temel risk faktörlerinin belirlenmesi, advers olayların görülme sıklığının en aza indirilmesine ve hasta sonuçlarının iyileştirilmesine yardımcı olabilir. Bu çalışmada toplanan veriler, ERCP'nin mevcut uygulaması ve modern gastroenterolojide oynadığı rol hakkında değerli bilgiler sağlamaktadır.

Keywords

ERCP, biliyer hastalıklar, terapötik endoskopi, ERCP sonrası pankreatit, advers olay oranları, retrospektif çalışma.

References

• McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg. 1968;167(5):752-756.
• Baron TH, Petersen BT, Mergener K, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 2006;63(4 Suppl):S29-34.
• Testoni PA, Mariani A, Giussani A, et al. SEIFRED group. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761
• Meagher S, Yusoff I, Kennedy W, et al. The roles of magnetic resonance and endoscopic retrograde cholangiopancreatography (MRCP and ERCP) in the diagnosis of patients with suspected sclerosing cholangitis: a cost-effectiveness analysis. Endoscopy. 2007;39(3):222-228.
• Smeets X, Bouhouch N, Buxbaum J, et al. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria. United European Gastroenterol J. 2019;7(4):557-564.
• Düzenli T, Durak İ, Kaya M, Köseoğlu H. Post endoscopic retrograde cholangiopancreatography pancreatitis risk factors: is postsphincterotomy bleeding another risk factor? Surg Laparosc Endosc Percutan Tech. 2024; 34(2):117.
• Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70(1):80-88.
• Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007;39(9):793-801.
• ASGE Standards of Practice Committee; Maple JT, Ben-Menachem T, Anderson MA, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1-9.
• Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001; 54(4):425-434.
• Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96(2):417-423.
• Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2020;52(2):127-149.
• Veitch AM, Vanbiervliet G, Gershlick AH, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut. 2016;65(3):374-89.
• Sun X, Liu Y, Hu Q, Zhao X, et al. Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy. J Int Med Res. 2021;49(3):300060521996912.
• Chen M, Wang L, Wang Y, et al. Risk factor analysis of post-ERCP cholangitis: a single-center experience. Hepatobiliary Pancreat Dis Int. 2018;17(1):55-58.
• Ding X, Zhang F, Wang Y. Risk factors for post-ERCP pancreatitis: a systematic review and meta-analysis. Surgeon. 2015;13(4):218-229.
• Dolan RD, Ryou M. Endoscopic simulators: training the next generation. Curr Opin Gastroenterol. 2021;37(6):589-595.