Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

Risk Factors for Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography in Patients With Surgically Altered Anatomy: A Retrospective Study

Introduction : Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI, 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI, 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI, 2.693-466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

The effect of duration time on the efficacy and safety during endoscopic papillary balloon dilation for choledocholithiasis treatment

Background Endoscopic papillary balloon dilation (EPBD) has been widely accepted as an alternative to endoscopic sphincterotomy (EST) during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis treatment. No consensus has been established to define the precise duration of EPBD. Methods The PubMed, EMBASE, Cochrane Library database were systematically searched up to 31 May 2019 for research comparing short duration (≤ 30 seconds) and long duration (≥ 1 minute) of EPBD. Results Seven studies demonstrated that EPBD with long duration was superior than short duration in the stone clearance rate during the first ERCP (OR 0.61, 95%CI [0.48, 0.77], P < 0.001). Long duration exhibited a trend of higher efficacy in total stone removal across all ERCP sessions (OR 0.98, 95%CI [0.73, 1.31], P = 0.89), less frequency of mechanical lithotripsy use (OR 1.22, 95%CI [0.79, 1.89], P = 0.37). Compared with long duration, short balloon time had lower rate of overall complications (OR 0.85, 95%CI [0.70, 1.04], P = 0.11) and post-ERCP pancreatitis (OR 0.81, 95%CI [0.63, 1.03], P = 0.09). No significance was identified in hemorrhage (OR 0.86, 95%CI [0.30, 2.44], P = 0.77), perforation (OR 0.54, 95%CI [0.14, 2.14], P = 0.38) and cholangitis (OR 1.15, 95%CI [0.80, 1.66], P = 0.44). Conclusion Long duration (≥ 1 minute) could significantly increase the efficacy of EPBD in stone removal rate during first ERCP session, manifesting higher rate of total CBD stone clearance and less mechanical lithotripsy. Short EPBD contributed to less overall complications than long EPBD but not significantly.