Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract

Table 1 Patient characteristics n (%)

Parameters		Value (n = 187)
Age, median (range)		72 (31-90)
Female sex,		49 (26)
Surgical anatomy
	Billroth-I	22 (12)
	Billroth-II	33 (18)
	Roux-en-Y	54 (29)
	Child or Whipple	75 (40)
	Others	3 (2)
Cause of surgery
	GU or DU	30 (16)
	Benign disease	14 (7)
	Benign tumor	29 (16)
	Malignant tumor	107 (57)
	N/A	7 (4)

DU: Duodenal ulcer; GU: Gastric ulcer; N/A: Not available.

Table 2 Success rates for procedures n (%)

Parameters		Value (n = 187)
Failure in reaching target site		17 (9)
Failed procedure		54 (29)
Procedure
	ERCP	23 (12)
	Drainage	43 (23)
	Stone treatment	29 (16)
	Stricture dilation	59 (32)
	N/A	33 (18)

ERCP: Endoscopic retrograde cholangiopancreatography; N/A: Not available.

Table 3 Incidence of adverse events n (%)

Parameters	Incidence (n = 187)
Pancreatitis	5 (3)
Hyperamylasemia	19 (10)
Cholangitis	12 (6)
Cholestasis	7 (4)
Excessive sedation	1 (1)
Perforation	3 (2)
Others	5 (3)
Total (no overlap)	47 (25)

Table 4 Risk factors for perforation in all cases n (%)

Parameters		n	Perforation	P value
Age (yr) ≥ 75		68	2 (2.9)	0.621
Female sex		49	2 (4.1)	0.345
Scope
	DBE	108	1 (0.9)	0.784
	Other scope	49	2 (4.1)	0.345
Cause of surgery
	malignancy	107	1 (0.9)	1
Type of surgical anatomy
	B-II	33	3 (9.1)	0.003
	R-Y	54	0 (0.0)	0.638

B-II: Billroth-II reconstruction; DBE: Double-balloon endoscope; R-Y: Roux-en-Y reconstruction.

Table 5 Risk factors for perforation in cases with Billroth-II reconstruction

	n	Perforation	P value
Age (yr) ≥ 75	25	2 (8)	1
Female sex	8	2 (25)	0.14
L shape	8	3 (37.5)	0.01
Retrocolic reconstruction	14	2 (14.3)	0.56
Surgery by malignancy	10	1 (10)	0.34
Time to papilla (> 15 min.)	14	3 (21.4)	0.07

L shape: Looped scope insertion.

Table 6 Clinical characteristics of three perforated Billroth-II cases

Case	Age	Sex	Diagnosis	Indication for an endoscopy	Reaching the target site	Cause of surgery	Therapy of perforation
1	67	F	Pancreatic cancer	Drainage	Success	Gastric cancer	Conservative
2	83	M	Biliary tract cancer	Drainage	Failure	Duodenal ulcer	Operation
3	82	F	Choledocholithiasis	Stone treatment	Failure	N/A	Operation

N/A: Not available.