Laparosc Endosc Surg Sci . 2021; 28(2): 93-98 | DOI: 10.14744/less.2021.58966

Post-ERCP complications, risk factors and management of complications

Ufuk Arslan¹, Hacý Murat Cayci², Gözde Doðan³, Umut Eren Erdogdu⁴, Ali Tardu⁵, Direnç Yiðit¹, Yurdakul Deniz Firat⁴, Müfit Þansal^1
1Department of Gastroenterological Surgery, Bursa State Hospital, Bursa, Turkey
²Department of Gastroenterological Surgery, Private Medical Office, Bursa, Turkey
³Department of General Surgery, Doruk Hospital, Bursa, Turkey
⁴Department of General Surgery, Bursa Yüksek Ýhtisas Training and Research Hospital, Bursa, Turkey
⁵Department of Gastroenterological Surgery, Irmed Hospital, Tekirdað, Turkey

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure used for the diagnosis and treatment of hepatopancreaticobiliary system diseases. The aim of this study is to evaluate post-ERCP complications, risk factors, and management of complications of ERCP procedures performed in the endoscopy unit of our hospital.
METHODS: The study retrospectively reviewed 765 patients’ data of ERCP performed by the same endoscopist for the diagnosis and treatment of hepatopancreaticobiliary diseases at a single center between April 2019 and February 2021. Interventional procedures were reviewed in terms of ERCP indications, procedure-related complications, risk factors for complications, and management of the complications.
RESULTS: A total of 765 procedures were carried out. The successful cannulation rate was 91.9%. The most common indicators for the ERCP procedure were choledocholithiasis (43.6%), high levels of cholestasis biomarkers/ intra-extrahepatic bile duct dilatation (19%) ve removal of bile duct stents (12.5%). The most common risk factors were; female gender (60.9%) and younger age (42.3%) for post-ERCP pancreatitis, pre-cut (10.9%) and anticoagulant therapy (7.5%) for bleeding, papillary abnormalities (22.4%) for perforation, and older age (42.8%) for cholangitis. The most common complications were hyperamylasemia and pancreatitis (17.2%), bleeding (2%), cholangitis (1.83), and perforation (0.65%). Mortality occurred in 0.26% of patients due to post-ERCP cholangitis.
DISCUSSION AND CONCLUSION: Understanding the risk factors and early diagnosis and treatment of complications are the ways to reduce morbidity and mortality in the management of post-ERCP complications.

Keywords: Complication, early diagnosis; endoscopic retrograde cholangiopancreatography; hepatopancreaticobiliary system; risk factors.

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ERCP sonrasý komplikasyonlar, risk faktörleri ve komplikasyonlarýn yönetimi

Ufuk Arslan¹, Hacý Murat Cayci², Gözde Doðan³, Umut Eren Erdogdu⁴, Ali Tardu⁵, Direnç Yiðit¹, Yurdakul Deniz Firat⁴, Müfit Þansal^1
1Bursa Þehir Hastanesi, Gastroenteroloji Cerrahisi, Bursa
²Özel Muayenehane, Gastroenteroloji Cerrahisi, Bursa
³Doruk Hastanesi, Genel Cerrahi, Bursa
⁴Bursa Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi, Bursa
⁵Irmed Hastanesi, Gastroenteroloji Cerrahisi, Tekirdag

GÝRÝÞ ve AMAÇ: Endoskopik retrograd kolanjio pankreatografi (ERCP), hepatopankreatikobiliyer sistem hastalýklarýnýn taný ve tedavisinde kullanýlan giriþimsel bir yöntemdir. Bu çalýþmanýn amacý hastanemiz endoskopi ünitesinde uygulanan ERCP iþlemleri sonrasý görülen komplikasyonlar, risk faktörleri ve komplikasyon yönetiminin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Nisan 2019- Þubat 2021 tarihleri arasýnda tek merkezde hepatopankreatikobiliyer sistem hastalýklarýnda taný ve tedavi amacýyla ayný endoskopist tarafýndan uygulanan 765 hastanýn ERCP verileri retrospektif incelendi. Ýþlemler; ERCP endikasyonlarý, iþleme baðlý komplikasyonlar, komplikasyonlar için risk faktörleri ve komplikasyonlarýn yönetimi açýsýndan deðerlendirildi.
BULGULAR: Yapýlan iþlem sayýsý 765 idi. Baþarýlý kanulasyon oraný % 91.9 olarak bulundu. ERCP iþlemi için en sýk endikasyonlar koledok taþý (%43.6), yükselmiþ kolestaz enzimleri/ intra-ekstrahepatik safra yolu dilatasyonu (%19) ve stent çýkarýlmasý (%12.5) idi. Post-Ercp pankreatit için en sýk izlenen risk faktörleri kadýn cinsiyet (%60.9) ve yaþ (%42.3), kanama için pre-cut (%10.9) ve antikoagulan kullanýmý (%7.5), perforasyon için anormal papilla (%22.4), kolanjit için yaþ (%42.8) idi. En sýk izlenen komplikasyonlar hiperamilazemi ve pankreatit (% 17.2), kanama (%2), kolanjit (% 1.83) ve perforasyon (% 0.65) olarak izlendi. Post ERCP kolanjitine baðlý % 0.26 hastada mortalite izlendi.
TARTIÞMA ve SONUÇ: ERCP sonrasý komplikasyon yönetiminde risk faktörlerinin iyi anlaþýlmasý, komplikasyonlarýn erken taný ve tedavisi ile morbidite ve mortalitenin azalabileceðini düþünmekteyiz.

Anahtar Kelimeler: Ercp, hepatopankreaticobiliyer sistem, komplikasyon, risk faktörü, erken taný

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