Complications of endoscopic retrograde cholangiopancreatography: A single center retrospective study

Öz

Background/aim: To document the complications of endoscopic retrograde cholangiopancreatography (ERCP). Materials and methods: The study involved retrospective analysis of 670 inpatients who underwent ERCP between January 1999 and November 2002 in the ERCP laboratory of Türkiye Yüksek İhtisas Hospital. Results: ERCP-related complications included 21 (3.1%) infections, 18 (2.7%) bleeding, 13 (1.9%) pancreatitis, 10 (1.5%) perforation and 6 (0.9%) other rare complications. There were a total of 8 (1.2%) deaths, due to perforation and infection (3 each) and bleeding and hepatic coma (1 each). Conclusion: ERCP is a valuable diagnostic and therapeutic procedure; however, it may have even mortal complications. The indications of ERCP should be put exactly and the procedures should be performed by experts to avoid unnecessary manipulations.

Anahtar Kelimeler

• Endoscopic retrograde cholangiopancreatography, complication

Endoskopik retrograd kolanjio-pankreatografi komplikasyonları: Tek merkezli retrospektif çalışma

Öz

Giriş ve amaç: Pankreatobilier hastalıkların tanı ve daha çok tedavisinde önemli rolü olan endoskopik retrograd kolanjiopankreatografiye (ERCP) bağlı gelişen komplikasyonların dokümentasyonu planlandı. Gereç ve yöntem: Ocak 1999 ve Kasım 2002 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi ERCP laboratuvarında ERCP yapılan 670 yatan hastaya ait kayıtlar retrospektif olarak değerlendirildi. Bulgular: 21 vakada (%3.1) enfeksiyon, 18'inde (%2.7) kanama, 13'ünde (%1.9) pankreatit, 10'unda (%1.5) perforasyon ve 6'sında (%0.9) diğer nadir komplikasyonlar gelişti. 3'ü perforasyon, 3'ü enfeksiyon, 1'i kanama ve 1'i de hepatik koma nedeniyle toplam 8 hasta (%1.2) kaybedildi. Sonuç: ERCP etkin olduğu ölçüde ölüme kadar varan komplikasyonları olabilen bir işlemdir. ERCP endikasyonu doğru konulmalı ve işlemler tecrübeli kişilerce gereksiz manipülasyonlardan kaçınarak yapılmalıdır.

Anahtar Kelimeler

• Endoskopik retrograd kolanjiopankreatografi, komplikasyon

Kaynakça

1. Freeman ML. Adverse outcomes of endoscopic retrograde cholan- giopancreatography. Rev Gastroenterol Dis 2002; 2: 147-68.
2. Loperfido S, Angelini G, Benedetti G, et al. Major early complicati- ons from diagnostic and therapeutic ERCP: a prospective multicen- ter study. Gastrointest Endosc 1998; 48: 1-10.
3. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroen- terol 2001; 96: 417-23.
4. Rabenstein T, Schneider HT, Bulling D, et al. Analysis of the risk factors associated with endoscopic sphincterotomy techniques: pre- liminary results of a prospective study, with emphasis on the redu- ced risk of pancreatitis with low-dose anticoagulation treatment. Endoscopy 2000; 32: 10-9.
5. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc 2002; 56: 273-82.
6. Sherman S, Lehman GA. Complications of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. In: Barkin J, O’Phelan CA, eds. Advanced Therapeutic Endoscopy New York: Raven Press; 1990: 201-10.
7. Freeman ML, Nelson DB, Sherman S, et al. Complications of endos- copic biliary sphincterotomy. N Engl J Med 1996; 335: 909-18.
8. Freeman ML, Nelson DB, Sherman S, et al. Same-day discharge af- ter endoscopic biliary sphincterotomy: observations from a pros- pective multicenter complications study. Gastrointest Endosc 1999; 49: 580-6.

9. Leung JWC, Chan FKL, Sung JJY, Chung S. Endoscopic sphincte- rotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc 1995; 42: 550-4.
10. Siegel HJ, Kasmin FE. Biliary tract diseases in the elderly: mana- gement and outcomes. Gut 1997; 41: 433-5.
11. Deans GT, Sedman P, Martin DF, et al. Are complications of endos- copic sphincterotomy age related? Gut 1997; 41: 545-8.
12. Cotton PB, Chapman M, Whiteside CG, Le Quesne LP. Duodenos- copic papillotomy and gallstone removal. Br J Surg 1976; 63: 709- 14.