Evaluation of risk factors, primary diagnosis, causes, and outcomes of repeat endoscopic retrograde cholangiopancreatography

Abstract

Background : : Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive endoscopic method that is used for the diagnosis and treatment of pancreaticobiliary diseases. ERCP may have to be performed two or more times, which carries a risk of complications and even death. Various risk factors influence the likelihood of ERCP recurrence.Methods : : A retrospective study was conducted at Pauls Stradins Clinical University Hospital. Fifty patients with a history of repeat ERCP were enrolled. The total ERCP count was 122. The total death rate, 30-day postprocedural mortality, laboratory markers, and primary diagnosis were analyzed, and the therapeutic interventions used during ERCP, common bile duct’s diameter, and causes of repeat ERCP were evaluated.Results : : The postprocedural 30-day mortality of repeat ERCP was 3.3%, and the overall death rate was 8%. We found a significant difference between the number of repeat ERCPs and exitus letalis (mean = 2.25 vs. mean = 1.37). The most common primary diagnosis for repeat ERCP was choledocholithiasis (64%; n = 32). We found a significant relationship between choledocholithiasis and history of cholecystectomy (P < 0.001) and obesity (P < 0.001). The rate of successful cannulation for ERCP reached 88.5%, with a significant difference between the success of cannulation and bilirubin level (205.64 ± 234.42 μmol/L vs. 58.71 ± 97.65 μmol/L, P = 0.037). The results showed a significant relationship between the success of cannulation and the presence of jaundice (P = 0.014) and periampullary diverticulum (P = 0.017).Conclusion : : A greater number of repeated ERCPs carries a higher risk of overall death outcome. The disturbances in laboratory markers (decreased hemoglobin; elevated leucocytes, bilirubin, creatinine, alkaline phosphatase, C-reactive protein) could be a risk factor for negative 30-day postprocedural outcome. The risk factors for repeating ERCP include adiposity, history of cholecystectomy, bilirubin level, jaundice, and periampullary diverticulum.

Keywords

• cholangiopancreatography
• endoscopic retrograde; choledocholithiasis; jaundice; mortality; risk factors