Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2016; 8(19): 709-715
Published online Nov 16, 2016. doi: 10.4253/wjge.v8.i19.709
Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity
Ayman El Nakeeb, Ehab El Hanafy, Tarek Salah, Ehab Atef, Hosam Hamed, Ahmad M Sultan, Emad Hamdy, Mohamed Said, Ahmed A El Geidie, Tharwat Kandil, Mohamed El Shobari, Gamal El Ebidy
Ayman El Nakeeb, Ehab El Hanafy, Tarek Salah, Ehab Atef, Hosam Hamed, Ahmad M Sultan, Emad Hamdy, Mohamed Said, Ahmed A El Geidie, Tharwat Kandil, Mohamed El Shobari, Gamal El Ebidy, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
Author contributions: El Nakeeb A designed the research; El Nakeeb A, El Hanafy E, Salah T, Atef E, Hamed H, Sultan AM, Hamdy E, Said M, El Geidie AA, KandilT, El Shobari M and El Ebidy G performed the research; El Nakeeb A and Said M analyzed data; El Nakeeb A and Hamed H wrote the paper.
Institutional review board statement: This study was approved by the institutional review board of Mansoura University.
Informed consent statement: All patients underwent ERCP after a careful explanation of the nature of the disease and possible complications.
Conflict-of-interest statement: There are no potential conflicts of interest relevant to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman El Nakeeb, Associate Professor, Gastroenterology Surgical Center, Mansoura University, El Gomhouria St, Mansoura 35516, Egypt. elnakeebayman@yahoo.com
Telephone: +2-50-2353430 Fax: +2-50-2243220
Received: June 5, 2016
Peer-review started: June 6, 2016
First decision: July 20, 2016
Revised: July 27, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 16, 2016
Abstract
AIM

To detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity.

METHODS

This is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected.

RESULTS

The study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP.

CONCLUSION

PEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

Keywords: Pancreatitis, Obstructive jaundice, Endoscopic retrograde cholangiopancreatography

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly used for therapeutic management of various biliary and pancreatic diseases. However, ERCP is not a procedure without morbidities. Post-ERCP pancreatitis (PEP) remains the most devastating and frequent complication after ERCP. Identification of risk factors for PEP helps adopt prophylactic measures in high risk patients and early discharge in low risk patients. Age less than 35 years, narrower median common bile duct diameter and increased number of pancreatic cannulations were identified to be independent risk factors for the occurrence of PEP.