title: Post-ERCP pancreatitis in 2364 ERCP procedures: is intraductal ultrasonography another risk factor?
abstract: OBJECTIVE
  Acute pancreatitis is considered a relevant major complication following endoscopic retrograde cholangiopancreatography (ERCP); according to literature data, the incidence varies between 1.5 % and 17 %. In the present study, we aimed to identify potentially new, hitherto unknown risk factors for post-ERCP pancreatitis.
  
  
  METHODS
  A total of 2364 ERCP procedures performed in 1275 patients during the years 2004 - 2008 were included in the study. Post-ERCP pancreatitis was defined as acute abdominal pain within 48 hours following ERCP with at least 3-fold elevated levels of serum lipase and a requirement for analgesic drugs for at least 24 hours. The severity of the pancreatitis was determined using the Imrie score.
  
  
  RESULTS
  In our cohort study a total of 54 different patients (2.3 %) developed post-ERCP pancreatitis. In 50 of these patients (92.6 %) the pancreatitis was mild; in 54 (7.4 %) it was severe. Patients with post-ERCP pancreatitis had highly significantly lower bilirubin levels than patients who did not have post-ERCP pancreatitis ( P < 0.001). Length of hospital stay, duration of analgesics, and need for analgesic drugs were significantly higher in patients suffering from severe pancreatitis ( P ≤ 0.01). In multivariate analysis, among other, already well-described risk factors we identified intraductal ultrasonography as another risk factor for post-ERCP pancreatitis, with a hazard ratio of 2.41 ( P = 0.004).
  
  
  CONCLUSIONS
  According to our retrospective data, intraductal ultrasonography seems to be another independent risk factor for developing post-ERCP pancreatitis, which needs to be further elucidated in prospective studies.
authors.affiliation: Department of Medicine B, University of Münster, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Meister
authors.forename: H
authors.initials: H
authors.lastname: Heinzow
authors.forename: A
authors.initials: A
authors.lastname: Heinecke
authors.forename: R
authors.initials: R
authors.lastname: Hoehr
authors.forename: W
authors.initials: W
authors.lastname: Domschke
authors.forename: D
authors.initials: D
authors.lastname: Domagk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D019160:Endosonography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008049:Lipase