Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis.
BACKGROUND
The rate of complications after endoscopic sphincterotomy (ES) is about 10%, and early complications have been reported in 20% of patients considered unfit for surgery.


OBJECTIVE
To evaluate the early and long-term results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis.


METHODS
All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were evaluated according to the American Society of Anesthesiology (ASA) criteria immediately before the operative procedure. Patients' ASA scores were as follows: 49.4%, ASA 2; 29.9%, ASA 3; and 20.7%, ASA 4.


RESULTS
The severity of acute pancreatitis was positively related to the anesthesiological grade (p = 0.014). Six patients (6.9%) had complications related to the endoscopic procedure. There was no significant relationship between the frequency of biliopancreatic complications during the follow-up (23/84, 27.4%) and the ASA grade. The frequency of cholecystectomy was inversely related to the ASA grade (p = 0.003). Seven patients (8.3%) died during the follow-up period: multivariate analysis showed that the ASA grade (odds ratio [OR], 10.9; 95% confidence interval [CI], 1.2-96.6; p = 0.001) and age (OR, 1.1; 95% CI, 1.0-1.3; p = 0.037) were significantly related to survival.


CONCLUSIONS
Endoscopic treatment is safe and effective in patients at high anesthesiological risk with acute pancreatitis, and survival is significantly related to the ASA grade.
Pezzilli
Raffaele
R
Department of Internal Medicine, Sant'Orsola-M. Malpighi Hospital, Bologna, Italy. pezzilli@orsola-malpighi.med.unibo.it
Billi
Paola
P
Morselli-Labate
Antonio Maria
AM
Barakat
Bahjat
B
D'Imperio
Nicola
N
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data