Therapeutic ERCP: the analysis of intra- and postoperative complications and long-term outcome

Abstract

Aim. To study complications and outcome of therapeutic endoscopic retrograde pancreatocholangiography (ERCP) in patients with benign and malignant pathology of pancreatobiliary system. Material and Methods. During 15-year period, 20534 therapeutic ERCP were performed: sphincterotomy or/and balloon dilation of Vater's papilla (20534) with stone extraction (12680), lithotripsy (4384), endobiliary stenting (939), endoscopic papillectomy (41). Results and Discussion. 856 (4.17%) patients had complications after therapeutic ERCP: hemorrhage from place of sphincterotomy or ampullectomy - 441 (2.15%) patients, acute pancreatitis - 377 (1.84%), basket impaction - 37 (0.18%), perforation - 24 (0.12%), while 23 (0.11%) patients had several types of complications. Because of complications, 50 (0.24%) patients underwent surgery; total ERCP-related mortality was 0.058%. After ERCP, long-time follow-up revealed recurrent choledocholithiasis in 1127 (6.60% from patients with cholelithiasis), ascended cholangitis - 79 (0.38%), benign recurrent stenosis of Vater's papilla or of distal part of common bile duct - 109 (0.53%), benign stricture of bile ducts - 12 (0.06%). Causes, diagnostics, prevention, and management of these complications are discussed. Conclusions. The main causes of complication of ERCP were found to be the following: incomplete investigation of patient or incorrect evaluation of his physiologic peculiarities, changes of Vater's papilla region or unwarranted unwary performing of endoscopic procedure. The application of minimally invasive treatment and medication had positive impact on most patients with ERCP adverse events.

Keywords

• therapeutic ercp, complications, outcome