Cpre

1130-0108/2004/96/3/163-173 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2004 ARÁN EDICIONES, S. L.

REV ESP ENFERM DIG (Madrid) Vol. 96. N.° 3, pp. 163-173, 2004

ORIGINAL PAPERS

Complications of endoscopic retrograde cholangiopancreatography. A study in a small ERCP unit
J. García-Cano Lizcano, J. A. González Martín, J. Morillas Ariño and A. Pérez Sola
Service of DigestiveDiseases. Hospital Virgen de la Luz. Cuenca, Spain

ABSTRACT
Backgrounds and aim: endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure to drain the biliary and pancreatic ducts. Nevertheless, there are complications which seem to be more common in centers performing less than 200 ERCPs per year. Sometimes, however, due to the distribution of health resources, it isnecessary to perform this technique in centers with a smaller number of procedures. We present the experience of ERCP-related complications in a small unit. Material and methods: this is a retrospective study on prospective data recorded during six years (1997-2002). In this period, two endoscopists working together performed 507 ERCPs, which yields an approximately average of 84 procedures peryear. Results: in 507 ERCPs performed during this period of time, 55 complications arose (10.85%), and four patients died (0.79%) as a consequence of the procedure. There were 28 pancreatitis (5.5%), eight post-sphincterotomy bleeding events (1.6%), seven bilioduodenal perforations (1.4%), eight sepsis episodes of biliary origin (1.6%), and other 4 different complications. There were 418 (82.4%)successful ERCPs –either diagnostic or therapeutic–, which gave rise to 46 (11%) complications. There were 89 (17.6%) failed diagnostic or therapeutic ERCPs, which gave rise to 9 (10.11%) complications (p = 0.8 between both groups). Thirty five (7%) ERCPs were exclusively diagnostic and caused 6 (17%) complications. The 187 procedures performed for coledocholithiasis originated 14 (7.4%)complications, and represented the group with the lowest morbidity rate (p = 0.04). Conclusions: the complications rate in our center is within the range of reported figures. ERCPs performed for choledocolithiasis was associated with the lowest complications rate. The risk-benefit ratio in the anticipated, purely diagnostic ERCP must be carefully weighed due to its morbidity.

García-Cano Lizcano J, GonzálezMartín JA, Morillas Ariño J, Pérez Sola A. Complications of endoscopic retrograde cholangiopancreatography. A study in a small ERCP unit. Rev Esp Enferm Dig 2004; 96: 163-173.

INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is a very effective procedure to drain both the biliary and pancreatic ducts (1). Nowadays, available methods to image the pancreatobiliary system,specially magnetic resonance cholangiopancratography (MRCP), have turned ERCP into an eminently therapeutic procedure. Gaining access to the bile and pancreatic ducts, sphincterotomy, choledocholithiasis extraction, and biliary and pancreatic stent insertion are the more difficult procedures in digestive endoscopy (2). The complexity of the procedure entails a morbidity that seems to be higher incenters performing few explorations. Though no unanimously accepted criteria exist, minimal standards have been fixed in 200 ERCPs per year (3), more than one sphincterotomy every week (4), or at least 40 sphincterotomies per year for each endoscopist (5). Nevertheless, the distribution and access of patients to health resources can generate the need to perform this technique in hospitals in which alimited volume of procedures is annually expected. We present our experience regarding ERCP-related complications in a small unit. MATERIAL AND METHODS During a 6-year period (1997-2002) two endoscopists (JGL and JGM), working together, performed 507 ERCPs.

Key words: ERCP complications.

Recibido: 20-01-03. Aceptado: 03-09-03. Correspondencia: J. García-Cano Lizcano. Residencial Los Alfares,...