Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center.
OBJECTIVE
The majority of recent large series on endoscopic retrograde cholangiopancreatography (ERCP) complications have been multicenter studies reflecting varying degrees of experience and ERCP volume; major ERCP complications are associated with low case volume. The aim of this study was to report and analyze the frequency of severe and fatal complications associated with ERCP at a single specialized surgical high-volume referral center (Turku University Central Hospital).


METHODS
All scheduled ERCP procedures (n = 2788) at our unit between January 1997 and December 2005 were included and the procedure-related severe and fatal complications were assessed by retrospective chart review. Complications were classified as severe or fatal according to standardized guidelines.


RESULTS
The number of ERCP procedures performed was 2555, of which 71% were therapeutic and 29% were diagnostic. Seventeen (0.8%) severe complications were identified in 16 patients, of whom 15 underwent a therapeutic endoscopic procedure. Of the 17 severe complications, perforation constituted five cases (0.2%), pancreatitis occurred in five patients (0.2%), bleeding in five cases (0.2%), and two patients suffered from purulent cholangitis (0.1%). Procedure-related mortality was 0.08% (n = 3).


CONCLUSIONS
In our study the rate of severe or fatal complications of ERCP is low in experienced hands at a high-volume center, comparing favorably to corresponding complication rates of multicenter series, which further supports the importance of centralizing ERCP procedures in high-volume advanced centers.
Salminen
P
P
Department of Surgery, Turku University Central Hospital, Turku, Finland. paulina.salminen@tyks.fi
Laine
S
S
Gullichsen
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000293:injuries; D002423:Cause of Death; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000401:mortality; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D004386:Duodenum / Q000293:injuries; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000401:mortality; D017211:Treatment Failure