Different pattern of risk factors for post-ERCP pancreatitis in patients with biliary stricture

Scand J Gastroenterol. 2018 May;53(5):604-610. doi: 10.1080/00365521.2017.1392599. Epub 2017 Nov 9.

Abstract

Objective: To identify possible risk factors associated with post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in biliary stricture (BS), common bile duct stone (CBDS) and unselected patients.

Materials and methods: Consecutive ERCP patients with native papilla from January 2010 to December 2014 in Xijing Hospital were eligible. Patient-related and procedure-related parameters were collected retrospectively. The primary outcome was PEP. Univariate and multivariate logistic regression were used for data analysis.

Results: Totally 3133 unselected patients were included. 695 (22.2%) had BS alone and 1893 (60.4%) had CBDS alone. PEP incidence was higher in BS group compared with CBDS group (6.8% vs. 3.8%, p = .001). Among patient-related factors, duodenal stenosis (OR, 2.74; 95%CI, 1.14-6.59) and hilar stricture (OR, 2.59; 95%CI, 1.41-4.77) were found to be independently associated with PEP in BS group. While female gender (OR, 2.11; 95%CI, 1.20-3.73) and normal total bilirubin (OR, 1.93; 95%CI, 1.13-3.32) were related to PEP in CBDS group. Among procedure-related factors, cannulation time ≥ 5 min (OR, 2.38; 95%CI, 1.06-5.33) and precut (OR, 3.20; 95%CI, 1.35-7.59) was respectively the only independent risk factor for PEP in BS and CBDS group.

Conclusions: Patients with BS and CBDS had different patterns of patient-related and procedure-related risk factors for PEP. The prophylaxis of PEP may need to be individualized based on different indications.

Keywords: Post-ERCP pancreatitis; biliary stricture; duodenal stenosis; hilar stricture; risk factors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Catheterization / adverse effects
  • China / epidemiology
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Cholestasis / complications
  • Cholestasis / surgery*
  • Constriction, Pathologic
  • Female
  • Gallstones / complications
  • Gallstones / surgery*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pancreatitis / epidemiology*
  • Pancreatitis / etiology*
  • Retrospective Studies
  • Risk Factors