Vandervoort et al identified risk factors associated with complications following Endoscopic Retrograde Cholangiopancreatography (ERCP). This can help identify patients who may benefit from closer monitoring and followup. The authors are from Brigham & Women's Hospital and Harvard Medical School in Boston.
The most common complications after ERCP are:
(1) acute pancreatitis
(2) bleeding
Independent risk factors for complications from multivariate logistic regression:
(1) recurrent episodes of pancreatitis
(2) previous episode of ERCP-related pancreatitis
(3) multiple attempts at cannulation the ampulla
(4) attempting pancreatic brush cytology
(5) pain during the procedure
Risk Factor
Odds Ratio
IQR
recurrent pancreatitis
2.01
1.10 – 3.59
previous episode ERCP-related pancreatitis
2.61
1.33 – 4.97
multiple cannulation attempts
2.81
1.57 – 5.30
pancreatic brush cytology
2.86
1.08 – 7.25
pain during the procedure
5.90
3.42 – 10.12
from Table 3, page 655
where:
• The risk for complications was 3.3% with <= 5 cannulation attempts, about 9% with 6 to 20 attempts, and 15% with > 20 attempts. I will use >= 6 for the cutoff in the implementation.
• 2 of the risk factors would be known before starting the procedure. It would seem prudent to avoid the other risk factors in these patients.
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