Document Detail

Risk factors for ERCP-related complications in patients with pancreas divisum: a retrospective study.
MedLine Citation:
PMID:  21392753     Owner:  NLM     Status:  MEDLINE    
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.
Dana C Moffatt; Gregory A Coté; Haritha Avula; James L Watkins; Lee McHenry; Stuart Sherman; Glen A Lehman; Evan L Fogel
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-03-09
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  73     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-27     Completed Date:  2011-09-27     Revised Date:  2012-04-26    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  963-70     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Indiana University, Indianapolis, Indiana, USA.
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde*
Follow-Up Studies
Indiana / epidemiology
Middle Aged
Pancreas / abnormalities*,  radiography
Pancreatitis / epidemiology,  etiology*
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Comment In:
Endoscopy. 2012 Apr;44(4):389-93   [PMID:  22438149 ]

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