Risk factors for pancreatitis after pancreatic sphincterotomy

Both patient characteristics and technical factors modify the risk profile for post- endoscopic retrograde cholangiopancreatography pancreatitis, reports the latest issue of Endoscopy.

Endoscopic pancreatic sphincterotomy is indispensable for many therapeutic endoscopic maneuvers.

However, it is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).

Dr Hookey and colleagues investigated a subgroup of patients in order to identify risk factors and protective factors of pancreatitis after ERCP.

The researchers reviewed a retrospective chart, which identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria.

The research team examined charts for indications, endoscopic technique, and outcomes, including pancreatitis.

A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period.

Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 12%

Endoscopy

Indications for sphincterotomy included chronic pancreatitis in 398 of cases, access for tissue sampling in 52, and acute recurrent pancreatitis in 45 cases.

Transpapillary drainage of a pancreatic pseudocyst in 32 cases, and precut access to the common bile duct in 29 cases were also indications of sphincterotomy.

The researchers observed that pancreatic duct drainage was performed in 69% of the procedures.

The team noted that post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 12%, and was severe in 10 cases.

The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis.

The team found that an elevated C-reactive protein level, pancreatic ductal stones, sphincterotomy at only the major papilla were associated with a lower risk.

Pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk.

Dr Hookey's team concludes, “This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post- endoscopic retrograde cholangiopancreatography pancreatitis.”

“In addition to providing further definition of which patients are at risk, it also suggests that pancreatic duct drainage is an independently significant protective maneuver.”