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Single-endoscopist Experience: ERCP Results, Complications, and Related factors

Year 2021, Volume: 12 Issue: 42, 10 - 17, 15.04.2021
https://doi.org/10.17944/mkutfd.810551

Abstract

ABSTRACT

Background / Aims: This study aimed to report our single-endoscopist endoscopic retrograde cholangiopancreatography (ERCP) experience, including ERCP success rate, complication rates and factors affecting them.

Materials and Methods: Retrospective data were collected from 573 patients who underwent ERCP from 2018 to 2020 at our clinic. Patients aged under 18 years, patients who had previously undergone ERCP at another center, patients using rectal non-steroidal anti-inflammatory drugs, patients with sedation-related complications , and patients using pancreatoxic medication were not included.
Results: The average age of the 573 patients included in the study was calculated as 58.6 (min. 18 - max. 104) years. In the examination of the success of cannulation, target duct was intubated in 93.9% (538/573) of the patients. In our study, the rate of post ercp pancreatitis was seen 7% , post ercp bleeding was observed as 1.2% , the rate of post ercp cholangitis was 0.9% , the post ercp perforation rate was 0.5% .When we compared the complications between successful and unsuccessful groups, there was a statistically significant difference in perforation and cholangitis (p<0.001 – p<0.001 respectively)
Concusions: There are some strategies to reduce and manage ERCP-related complications. Larger studies are needed to identify these strategies.

References

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  • ASGE Standards of Practice Committee; Early DS, Ben-Menachem T, Decker GA, Evans JA, Fanelli RD, Fisher DA et al. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012; 75(6):1127-31. https://doi.org/10.1016/j.gie.2012.01.011
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  • Freeman ML, Nelson DB, Sherman S, Haber GB, Dorsher PJ, Moore JP et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996; 335(13):909-18. https://doi.org/10.1056/NEJM199609263351301
  • Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007; 102(8):1781-8. https://doi.org/10.1111/j.1572-0241.2007.01279.x
  • Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007; 39(9):793-801. https://doi.org/10.1055/s-2007-966723
  • Wang P, Li ZS, Liu F, Ren X, Lu N-H, Fan Z-N et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009; 104(1):31-40. https://doi.org/10.1038/ajg.2008.5
  • Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66(1):27-34. https://doi.org/10.1016/j.gie.2006.12.040
  • Patel D, Chopra S, Berman MD. Serious systemic toxicity resulting from use of tetracaine for pharyngeal anesthesia in upper endoscopic procedures. Dig Dis Sci 1989; 34(6):882-4. https://doi.org/10.1007/BF01540273
  • Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37:383-93. https://doi.org/10.1016/S0016-5107(91)70740-2
  • Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol. 2016;30:793-805. https://doi.org/10.1016/j.bpg.2016.10.007
  • Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006;101:139-47. https://doi.org/10.1111/j.1572-0241.2006.00380.x
  • Cheon YK, Cho KB, Watkins JL, McHenry L, Fogel EL, Sherman S et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc. 2007;65:385-93. https://doi.org/10.1016/j.gie.2006.10.021
  • 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;70:80-8. https://doi.org/10.1016/j.gie.2008.10.039
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  • Ding X, Zhang F, Wang Y. Risk factors for post-ERCP pancreatitis: a systematic review and meta-analysis. Surgeon J R Coll Surgeon Edinb Irel. 2015;13:218-29. https://doi.org/10.1016/j.surge.2014.11.005
  • Chen JJ, Wang XM, Liu XQ, Li W, Dong M, Suo ZW et al. Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years. Eur J Med Res. 2014;19(1):26. https://doi.org/10.1186/2047-783X-19-26
  • Lee TH, Park do H, Park JY, Kim EO, Lee YS, Park JH et al. Can wire-guided cannulation prevent post- ERCP pancreatitis? A prospective randomized trial. Gastrointest Endosc. 2009; 69(3 pt 1):444-49. https://doi.org/10.1016/j.gie.2008.04.064
  • Maeda S, Hayashi H, Hosokawa O, Dohden K, Hattori M, Morita M et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy. 2003;35(9):721-24. https://doi.org/10.1055/s-2003-41576
  • Kaffes AJ, Sriram PV, Rao GV, Santosh D, Reddy DN. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc. 2005;62(5):669-74. https://doi.org/10.1016/j.gie.2005.05.022
  • Maple JT, Keswani RN, Hovis RM, Saddedin EZ, Jonnalagadda S, Azar RR et al. Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial. Gastrointest Endosc. 2009;70:278-83. https://doi.org/10.1016/j.gie.2008.12.050
  • Tse F, Yuan Y, Moayyedi P, Leontiadis GI. Guidewire-assisted cannulation of the common bile duct for the prevention of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev. 2012;12(12):Cd009662. https://doi.org/10.1002/14651858.CD009662
  • Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425-34. https://doi.org/10.1067/mge.2001.117550
  • Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP, Montes H et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002;56:652-56. https://doi.org/10.1016/S0016-5107(02)70112-0
  • Lida T, Kaneto H, Wagatsuma K, Sasaki H, Naganawa Y, Nakagaki S et al. Can trainees safely perform endoscopic treatments for common bile duct stones? A single-center retrospective study. Intern Med (Tokyo, Jpn). 2018;57:923-28. https://doi.org/10.2169/internalmedicine.9737-17
  • De-Madaria E. Statins for the prevention of acute pancreatitis. Am J Gastroenterol. 2017;112(12):1765-67. https://doi.org/10.1038/ajg.2017.396
  • Kuoppala, J, Pulkkinen J, Kastarinen H, Kiviniemi V, Jyrkka J, Enlund H et al. Use of statins and the risk of acute pancreatitis: a population- based case-control study. Pharmacoepidemiol Drug Saf. 2015; 24(10), 1085-92. https://doi.org/10.1002/pds.3858
  • Lee PJ, Modha K, Chua T, Chak A, Jang D, Lopez R et al. Association of statins with decreased acute pancreatitis severity: a propensity score analysis. J. Clin. Gastroenterol. 2018;52(8):742-46. https://doi.org/10.1097/MCG.0000000000000956
  • Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruinig DH et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85:32- 47. https://doi.org/10.1016/j.gie.2016.06.051
  • Chen M, Wang L, Wang Y, Wei W, Yao YL, Ling TS et al. Risk factor analysis of post- ERCP cholangitis: a single-center experience. Hepatobiliary Pancreat Dis Int. 2018;17:55-8. https://doi.org/10.1016/j.hbpd.2018.01.002
  • Subhani JM, Kibbler C, Dooley JS. Review article: antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). Aliment Pharmacol Ther. 1999;13(2):103-16. https://doi.org/10.1046/j.1365-2036.1999.00452.x
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Tek Endoskopist Deneyimi; ERCP Sonuçları, Komplikasyonlar ve İlgili Faktörler

Year 2021, Volume: 12 Issue: 42, 10 - 17, 15.04.2021
https://doi.org/10.17944/mkutfd.810551

Abstract

Amaç: Bu çalışmada, tek endoskopist endoskopik retrograd kolanjiyopankreatografi (ERCP) deneyimimizi, ERCP başarı oranı, komplikasyon oranları ve bunları etkileyen faktörler dahil olmak üzere bildirmeyi amaçlanmıştır.
Gereç ve Yöntem: Kahramanmaraş şehir hastanesiz gastroenteroloji kliniğine 2018-2020 yılları arasında ERCP uygulanan 723 hastadan geriye dönük veriler toplandı. 18 yaşın altındaki hastalar, daha önce başka bir merkezde ERCP uygulanan hastalar, rektal steroid olmayan antiinflamatuvar ilaçlar kullanan hastalar, sedasyona bağlı komplikasyonları olan hastalar ve pankreatoksik ilaç kullanan hastalar dahil edilmemiştir.
Bulgular: Çalışmaya dahil edilen 573 hastanın yaş ortalaması 58,6 (min. 18 - maks. 104) yıl olarak hesaplandı. Kanülasyonun başarısı incelendiğinde hastaların% 93.9'una (538/573) hedef kanala ulaşıldığı izlendi. Çalışmamızda ercp sonrası pankreatit oranı% 7, ercp sonrası kanama% 1.2, ercp sonrası kolanjit oranı% 0.9, ercp sonrası perforasyon oranı% 0.5 olduğu görüldü. İşlemde başarılı-başarısız gruplar karşılaştırıldığında başarısız grupta perforasyon ve kolanjitte istatistiksel olarak anlamlı fark mevcuttu (sırasıyla p <0.001 - p <0.001).
Sonuç: ERCP ile ilgili komplikasyonları azaltmak ve yönetmek için bazı stratejiler vardır. Bu stratejileri belirlemek için daha büyük çalışmalara ihtiyaç vardır.

References

  • ASGE Standards of Practice Committee; Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017; 85(1):32-47. https://doi.org/10.1016/j.gie.2016.06.051
  • ASGE Standards of Practice Committee; Early DS, Ben-Menachem T, Decker GA, Evans JA, Fanelli RD, Fisher DA et al. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012; 75(6):1127-31. https://doi.org/10.1016/j.gie.2012.01.011
  • ASGE Standards of Practice Committee; Chathadi KV, Chandrasekhara V, Acosta RD, Decker GA, Early DS, Eloubeidi MA et al. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015; 81(4):795-803. https://doi.org/10.1016/j.gie.2014.11.019
  • Freeman ML, Nelson DB, Sherman S, Haber GB, Dorsher PJ, Moore JP et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996; 335(13):909-18. https://doi.org/10.1056/NEJM199609263351301
  • Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007; 102(8):1781-8. https://doi.org/10.1111/j.1572-0241.2007.01279.x
  • Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007; 39(9):793-801. https://doi.org/10.1055/s-2007-966723
  • Wang P, Li ZS, Liu F, Ren X, Lu N-H, Fan Z-N et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009; 104(1):31-40. https://doi.org/10.1038/ajg.2008.5
  • Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66(1):27-34. https://doi.org/10.1016/j.gie.2006.12.040
  • Patel D, Chopra S, Berman MD. Serious systemic toxicity resulting from use of tetracaine for pharyngeal anesthesia in upper endoscopic procedures. Dig Dis Sci 1989; 34(6):882-4. https://doi.org/10.1007/BF01540273
  • Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37:383-93. https://doi.org/10.1016/S0016-5107(91)70740-2
  • Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol. 2016;30:793-805. https://doi.org/10.1016/j.bpg.2016.10.007
  • Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006;101:139-47. https://doi.org/10.1111/j.1572-0241.2006.00380.x
  • Cheon YK, Cho KB, Watkins JL, McHenry L, Fogel EL, Sherman S et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc. 2007;65:385-93. https://doi.org/10.1016/j.gie.2006.10.021
  • 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;70:80-8. https://doi.org/10.1016/j.gie.2008.10.039
  • Enochsson L, Swahn F, Arnelo U, Nilsson M, Lohr M, Persson G. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc. 2010;72:1175-84. https://doi.org/10.1016/j.gie.2010.07.047
  • Akashi R, Kiyozumi T, Tanaka T, Sakurai K, Oda Y, Sagara K. Mechanism of pancreatitis caused by ERCP. Gastrointest Endosc. 2002;55(1):50-4. https://doi.org/10.1067/mge.2002.118964
  • Pezzilli R, Romboli E, Campana D, Corinaldesi R. Mechanisms involved in the onset of post-ERCP pancreatitis. J Pancreas. 2002;3:162-8.
  • Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002; 56(suppl):S273-82. https://doi.org/10.1067/mge.2002.129028
  • Ding X, Zhang F, Wang Y. Risk factors for post-ERCP pancreatitis: a systematic review and meta-analysis. Surgeon J R Coll Surgeon Edinb Irel. 2015;13:218-29. https://doi.org/10.1016/j.surge.2014.11.005
  • Chen JJ, Wang XM, Liu XQ, Li W, Dong M, Suo ZW et al. Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years. Eur J Med Res. 2014;19(1):26. https://doi.org/10.1186/2047-783X-19-26
  • Lee TH, Park do H, Park JY, Kim EO, Lee YS, Park JH et al. Can wire-guided cannulation prevent post- ERCP pancreatitis? A prospective randomized trial. Gastrointest Endosc. 2009; 69(3 pt 1):444-49. https://doi.org/10.1016/j.gie.2008.04.064
  • Maeda S, Hayashi H, Hosokawa O, Dohden K, Hattori M, Morita M et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy. 2003;35(9):721-24. https://doi.org/10.1055/s-2003-41576
  • Kaffes AJ, Sriram PV, Rao GV, Santosh D, Reddy DN. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc. 2005;62(5):669-74. https://doi.org/10.1016/j.gie.2005.05.022
  • Maple JT, Keswani RN, Hovis RM, Saddedin EZ, Jonnalagadda S, Azar RR et al. Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial. Gastrointest Endosc. 2009;70:278-83. https://doi.org/10.1016/j.gie.2008.12.050
  • Tse F, Yuan Y, Moayyedi P, Leontiadis GI. Guidewire-assisted cannulation of the common bile duct for the prevention of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev. 2012;12(12):Cd009662. https://doi.org/10.1002/14651858.CD009662
  • Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425-34. https://doi.org/10.1067/mge.2001.117550
  • Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP, Montes H et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002;56:652-56. https://doi.org/10.1016/S0016-5107(02)70112-0
  • Lida T, Kaneto H, Wagatsuma K, Sasaki H, Naganawa Y, Nakagaki S et al. Can trainees safely perform endoscopic treatments for common bile duct stones? A single-center retrospective study. Intern Med (Tokyo, Jpn). 2018;57:923-28. https://doi.org/10.2169/internalmedicine.9737-17
  • De-Madaria E. Statins for the prevention of acute pancreatitis. Am J Gastroenterol. 2017;112(12):1765-67. https://doi.org/10.1038/ajg.2017.396
  • Kuoppala, J, Pulkkinen J, Kastarinen H, Kiviniemi V, Jyrkka J, Enlund H et al. Use of statins and the risk of acute pancreatitis: a population- based case-control study. Pharmacoepidemiol Drug Saf. 2015; 24(10), 1085-92. https://doi.org/10.1002/pds.3858
  • Lee PJ, Modha K, Chua T, Chak A, Jang D, Lopez R et al. Association of statins with decreased acute pancreatitis severity: a propensity score analysis. J. Clin. Gastroenterol. 2018;52(8):742-46. https://doi.org/10.1097/MCG.0000000000000956
  • Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruinig DH et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85:32- 47. https://doi.org/10.1016/j.gie.2016.06.051
  • Chen M, Wang L, Wang Y, Wei W, Yao YL, Ling TS et al. Risk factor analysis of post- ERCP cholangitis: a single-center experience. Hepatobiliary Pancreat Dis Int. 2018;17:55-8. https://doi.org/10.1016/j.hbpd.2018.01.002
  • Subhani JM, Kibbler C, Dooley JS. Review article: antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). Aliment Pharmacol Ther. 1999;13(2):103-16. https://doi.org/10.1046/j.1365-2036.1999.00452.x
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There are 53 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Articles
Authors

Ümit Karaoğullarından 0000-0003-4309-7845

Publication Date April 15, 2021
Submission Date October 14, 2020
Acceptance Date April 5, 2021
Published in Issue Year 2021 Volume: 12 Issue: 42

Cite

Vancouver Karaoğullarından Ü. Single-endoscopist Experience: ERCP Results, Complications, and Related factors. mkutfd. 2021;12(42):10-7.