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Gastrointest Endosc. 2011 May;73(5):963-70. doi: 10.1016/j.gie.2010.12.035. Epub 2011 Mar 9.

Risk factors for ERCP-related complications in patients with pancreas divisum: a retrospective study.

Author information

1
Indiana University, Indianapolis, Indiana, USA. dmoffatt@sbgh.mb.ca

Abstract

BACKGROUND:

Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply.

OBJECTIVES:

To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary care referral center.

PATIENTS:

A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010.

MAIN OUTCOME MEASUREMENTS:

Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP.

RESULTS:

Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P<.01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98).

LIMITATIONS:

Retrospective analysis of prospectively collected data.

CONCLUSIONS:

Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.

PMID:
21392753
DOI:
10.1016/j.gie.2010.12.035
[Indexed for MEDLINE]

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