Risk factors for endoscopic retrograde cholangiopancreatography-related cholangitis: a prospective study.
OBJECTIVE
Cholangitis is one of the most morbid complications of endoscopic biliary drainage and among the commonest causes of endoscopic retrograde cholangiopancreatography-related death. The aim of this prospective study was to investigate the risk factors for the development of cholangitis after endoscopic retrograde cholangiopancreatography in a tertiary referral center.


METHODS
The study involved 503 consecutive patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography. We included the cholangitis occurring within 72 hours after endoscopic retrograde cholangiopancreatography for all patients undergoing the procedure. All patients received antibiotic prophylaxis before endoscopic retrograde cholangiopancreatography. Factors including age, gender, presentation, nature of the papilla, therapeutic procedures, and the diagnosis were analyzed to predict post-endoscopic retrograde cholangiopancreatography cholangitis.


RESULTS
Median age was 61.2 +/- 14.8 years and there were 274 (54.5%) women and 229 (45.5%) men. Seventeen (3.3%) patients (9 F, 8 M) developed cholangitis after endoscopic retrograde cholangiopancreatography. The risk of post-endoscopic retrograde cholangiopancreatography cholangitis development was most probable in patients with hilar cholangiocarcinoma. Post-endoscopic retrograde cholangiopancreatography cholangitis risk was significantly higher in patients with biliary dilatation and biliary stent insertion, and without periampullary diverticula (odds ratio, OR: 4.8, 4.4, 1.2, respectively). Total procedure duration was significantly prolonged and common bile duct diameter was significantly increased in patients who had cholangitis. Five patients (3 F, 2 M; 0.9%) died because of post-endoscopic retrograde cholangiopancreatography complicated sepsis.


CONCLUSIONS
Increased common bile duct diameter, biliary dilatation, biliary stent insertion, prolonged total procedure time, and hilar cholangiocarcinoma have higher post-endoscopic retrograde cholangiopancreatography cholangitis risk. Moreover, the presence of periampullary diverticula was found to decrease cholangitis risk.
Ertuğrul
Ibrahim
I
Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. ibrahimer16@yahoo.com
Yüksel
Ilhami
I
Parlak
Erkan
E
Ciçek
Bahattin
B
Ataseven
Hilmi
H
Başar
Omer
O
Ibiş
Mehmet
M
Saşmaz
Nurgül
N
Sahin
Burhan
B
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D014421:Turkey / Q000453:epidemiology