Outcome and early complications of Endoscopic Retrograde Cholangio-Pancreatography (ERCP): a cross-sectional study on 626 Patients

Background. ERCP is the gold standard procedure for diagnosis and potential treatment of biliary-pancreatic disorders with various distributions in different areas of the world. The study aimed to evaluate the findings, outcome, complications and technical experiences of ERCP, also by considering the correlation of findings with liver function tests (LFT) and imaging.

Methods. In this descriptive – cross sectional data-based study for 12 years from 2007, 626 (43.9% male and 56.1%female; mean age 60 Ys) consecutive patients were subjected with therapeutic purpose at two referral hospitals.

Results. Epigastric pain (40%), jaundice (39.4%) and pruritus (38.1%) were the most common indications. CBD was cannulated by optimal wire- guided sphincterotomy in 486(77.6%) patients. Precut was performed in 65(10.6%) with successful cannulation in 61 cases (93.8%) and 7.7% of complications, including perforation. A total success rate of 98% was obtained. The most common diagnoses were CBD stone(s) in 322 (51.4%) and biliary-pancreatic cancers in 114 (18.2%) of cases. No LFT (ALT, ALP and Bilirubin) predicted the diagnoses. The higher concordance rate of imaging studies in comparison with ERCP was 75% for stone(s) and the lower rate of 11.1% for tumors. Metallic stents were used in 15(2.4%) of inoperable malignant cases with life expectancy of more than 6 months. Complications occurred in 29 cases (4.6%) including duodenal perforation (0.8%), pancreatitis (1.6%) and bleeding (1.2%). Mortality rate was 0.4%.

Conclusion. Although no single laboratory or imaging can exactly predict the finding or outcome, but by considering judicious case selection, appropriate use of available tools and standard techniques, the procedure could be safe with a few complications and higher success rates.