Procedural Outcomes and Peri-Procedural Complications of Endoscopic Retrograde Cholangiopancreatography: The Experience of a Tertiary Centre in the West of Ireland
Fennelly Evelyn, Harkin Grace, Lee John
Department of Gastroenterology, Galway University Hospital, Galway; School of Medicine, National University of Ireland, Galway
Endoscopic retrograde cholangiopancreatography (ERCP) is a complex endoscopic procedure which allows for minimally invasive management of pancreato-biliary disorders. However, its benefits are tempered by higher potential for complications than any other endoscopic technique(1,2), the most common complication being post-ERCP pancreatitis (PEP)(3).
To evaluate ERCP procedural outcomes and peri-procedural complications in a tertiary centre in the West of Ireland.
Patients who underwent ERCP at our institution from January 2010 to June 2015 were included. Retrospective demographic and procedural data was collected, using a standardised data collection form from a combination of endoscopy and radiology reports, discharge summaries and laboratory results. 62 patient charts were evaluated for more information. Statistical analysis was performed using SPSS v21.
430 ERCP’s were performed on 348 patients during the study period. The mean age was 64.03 years and 50.0% were female. The most common indication was choledocholithiasis (30.0%). Pancreatogram was obtained in 94.87% of procedures and cholangiogram in 74.65%. 74.59% of procedures involved interventions, including sphincterotomies (44.88%) and biliary stent insertion (20.9%). 74.47% procedures were successful or partially successful. The relationship between documented indication and successful outcome was significant (p <0.001) for all indications except cholangiocarcinoma (p 0.741). There was no statistically significant relationship between the age of patient and procedural success. The overall complication rate was 9.8%: PEP 5.1%, oxygen desaturation 1.6%, self-limiting bleeds 1.6%, minor bleeds 0.7%, perforations 0.5.%, sepsis 0.2%, acute kidney injury 0.2%. There were no haemorrhages, cardiopulmonary events, contrast allergy reactions, or peri-procedural deaths. Patients who had bleeds (selflimiting or minor) were older than the cohort average (mean age 74 years) and 71.4% were female. Higher dose of midazolam was a risk factor for oxygen desaturation (p <0.001). 96.28% procedures were performed using Midazolam, 63% with Pethidine; 32.09% with Fentanyl; and 2.09% under general anaesthesia. 3.26% procedures required administration of reversal agent. There is a negative correlation (-0.148) between age and midazolam dose which is statistically significant (p=0.003). Table 1 Mean dose all patients Mean dose of medication by age grouping 29 and under 30 – 59 60 and above Midazolam 4.94mg 7.39mg 6.63mg 4.10mg Pethidine 40.08mg 50.00mg 46.68mg 35.99mg Fentanyl 61.96μg 85.71μg 82.14μg 50.56μg
Procedural outcomes for ERCP were acceptable: 74.47% procedures were successful or partially successful; overall complication rate of 9.8%; there were no deaths, haemorrhages or cardiopulmonary events. PEP was the most common periprocedural complication, consistent with larger multicentre studies.