Endoscopic retrograde cholangiopancreatography-related pancreatitis and cholangitis differ according to biliary stricture anatomy: a cohort study
Theodoros Voulgaris, Vasileios Lekakis, Kleoniki Kordeni, Ioannis Vezakis, Orfeas-Petros Varvarelis, George Tribonias, Iwannis S. Papanikolaou, Andreas Polydorou, Antonios VezakisObjective
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and cholangitis are common complications. We evaluated whether stricture anatomy affects ERCP-related complications in patients with biliary strictures.
Methods
From a prospectively maintained ERCP database, 1333 procedures with biliary strictures were screened. Patients with prior sphincterotomy, acute gallstone pancreatitis, chronic pancreatitis, postsurgical biliary strictures, or periampullary adenomas or carcinomas were excluded. Epidemiological, clinical, laboratory, radiological, and therapeutic data, as well as post-ERCP follow-up information, were collected.
Results
In total, 789 patients were included (M/F: 53.1%/46.9%; mean age: 71 ± 13). Low strictures were observed in 490 (61.2%), while middle/high strictures were observed in 299 (38.8%). A pancreatic mass was documented in imaging 43%. Overall complications were higher in patients with middle/high versus low strictures (12.4% vs. 5.1%;
Conclusion
ERCP-related PEP and cholangitis in biliary strictures are strongly determined by stricture anatomy. Distal strictures – often associated with pancreatic mass – have significantly lower rates of PEP and cholangitis compared with middle/high strictures.