Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study

OBJECTIVES: To investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia. METHODS: Consecutive ERCP procedures were studied at 14 centers in China from May 2006 to April 2007. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors. RESULTS: A total of 3,178 procedures were performed on 2,691 patients. Overall, complications developed in 213 (7.92 %) patients, pancreatitis in 116 (4.31 %), and asymptomatic hyperamylasemia in 396 (14.72 %). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95 % confidence interval (CI): 1.14-2.02, P = 0.004), periampullary diverticulum (OR: 2.02, 95 % CI: 1.49-2.73, P < 0.001), cannulation time > 10 min (OR: 1.51, 95 % CI: 1.08-2.10, P = 0.016), >= 1 pancreatic deep wire pass (OR: 1.80, 95 % CI: 1.33-2.42, P < 0.001), and needle-knife precut (OR: 2.70, 95 % CI: 1.42-5.14, P = 0.002) were risk factors for overall complications. Female gender (OR: 1.84, 95 % CI: 1.25-2.70, P = 0.002), age <= 60 year (OR: 1.59, 95 % CI: 1.06-2.39, P = 0.025), cannulation time > 10 min (OR: 1.76, 95 % CI: 1.13-2.74, P = 0.012), >= 1 pancreatic deep wire pass (OR: 2.77, 95 % CI: 1.79-4.30, P < 0.001), and needle-knife precut (OR: 4.34, 95 % CI: 1.92-9.79, P < 0.001) were risk factors for pancreatitis. Cannulation time > 10 min (OR: 1.96, 95 % CI: 1.52-2.54, P < 0.001), >= 1 pancreatic deep wire pass (OR: 2.24, 95 % CI: 1.74-2.89, P < 0.001), needle-knife precut (OR: 2.34, 95 % CI: 1.32-4.14, P = 0.004), and major papilla pancreatic sphincterotomy (OR: 1.71, 95 % CI: 1.23-2.37, P = 0.001) were risk factors for asymptomatic hyperamylasemia. CONCLUSIONS: Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.