title: Complications of endoscopic retrograde cholangiopancreatography in primary sclerosing cholangitis.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in patients with primary sclerosing cholangitis (PSC). The risk of complications associated with this procedure is not well established in these patients. The aim of this retrospective study was to compare the risk of ERCP complications in PSC vs. non-PSC patients.
  
  
  METHODS
  We identified all Mayo Clinic patients who underwent ERCP in 2005. Procedural and clinical data were collected. Complications were defined as hospitalizations for pancreatitis, cholangitis, perforation, and bleeding.
  
  
  RESULTS
  A total of 168 patients with PSC and 981 patients without PSC had at least one ERCP examination in the calendar year 2005. PSC patients were younger (48 years+/-15 vs. 60 years+/-19, P<0.000) and had a higher prevalence of portal hypertension (31.5% vs. 4%, P<0.0001). PSC patients had more biopsies (39% vs. 15%, P<0.0001), brushings (37% vs. 8%, P<0.001), balloon dilatations (48% vs. 15%, P<0.0001), duct cytology (20% vs. 3%, P<0.0001) and intraductal ultrasounds (11% vs. 5%, P=0.007) than non-PSC patients. The duration of the procedure was longer in the PSC group (51 min+/-29 vs. 40 min+/-28, P<0.0001). The overall rate of complications in patients with PSC when compared to non-PSC patients was not significantly different (18/168 (11%) vs. 76/981(8%), P=0.2). The incidence of cholangitis was higher in the PSC group (4% vs. 0.2%, P<0.0002) despite routine use of antibiotics before the procedure in PSC patients. The duration of the procedure was longer in PSC patients who developed cholangitis (86 min+/-28 vs. 51 min+/-29, P=0.02). The risks of complications such as pancreatitis, perforation, and bleeding were not significantly different between the two groups despite their demographic and procedural variations. The duration of hospitalization due to complications was also not significantly different between the two groups.
  
  
  CONCLUSIONS
  Complications requiring hospitalizations occur in over 10% of PSC patients undergoing ERCP. Cholangitis occurs more often in PSC patients and correlates with the length of the procedure. Further studies to confirm the role of aggressive prophylactic antibiotics in patients with PSC who undergo prolonged procedures are warranted.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sanjay Y
authors.initials: SY
authors.lastname: Bangarulingam
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Gossard
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Ott
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000293:injuries / Q000601:surgery; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology / Q000209:etiology