Enns et al identified risk factors for perforations associated with endoscopic retrograde cholangiopancreatography (ERCP). These can help identify a patient who may benefit from a different procedure or closer monitoring after the ERCP. The authors are from the University of British Columbia, the University of Alabama, Virginia Mason Medical Center (Seattle), and Duke University.
Risk factors from multivariate analysis:
(1) sphincterotomy
(2) dilated common bile duct
(3) dysfunction of the sphincter of Oddi
(4) longer duration of the procedure (? more difficult)
(5) dilatation of a biliary duct stricture
Additional factors that may contribute:
(1) older age of the patient
(2) stricture in the pancreatic duct
(3) stricture in the common bile duct (if dilatation not attempted)
Sites of perforation:
(1) esophagus
(2) stomach
(3) duodenum
(4) bile duct
(5) pancreatic duct
Of patients who had a perforation, only about 21% required surgical repair.
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