What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis.
STUDY BACKGROUND AND AIMS: Predicting outcome at endoscopic retrograde cholangiopancreatography (ERCP) remains difficult. Our aim was to identify the risk factors for failed ERCP.


METHODS
A prospective multicenter study of ERCP was performed in 66 hospitals across England. Data on 4561 patients were collected using a structured questionnaire completed at the time of ERCP.


RESULTS
In total 3209 patients had not had an ERCP prior to the study period. Considering their first ever ERCP, 2683 (84 %) were successfully cannulated, 2241(70 %) had all intended therapy completed, 360 (11 %) had some intended therapy completed, and 608 (19 %) were considered to have had a failed procedure. For first ever ERCP, factors associated with incomplete procedure (odds ratio and 95 % confidence interval) were: Billroth surgery (9.2, 3.2 - 26.7), precutting (2.0, 1.6 - 2.7), common bile duct (CBD) stone size and number (3.2, 2.1 - 4.8 for multiple, large stones), interventions in the pancreatic duct (3.4, 1.6 - 7.0), and CBD stenting (2.8, 2.2 - 3.5). Analysis of the 1352 patients who had undergone an ERCP prior to the study period indicated previous failed ERCP was also predictive of incomplete therapy (1.5, 1.1 - 2.1). The modified Schutz score correlated with ERCP completion, as did the Morriston score, even when modified to include only variables measurable before the procedure.


CONCLUSIONS
This study confirms that patient- and procedure-based variables are key predictors of technical success and validates current methods of rating ERCP difficulty. Of note, a correlation between outcome and institutional factors, such as unit and endoscopist caseload, was not demonstrated.
Department of Gastroenterology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK. earl.williams@rbch.nhs.uk
E J
EJ
Williams
R
R
Ogollah
P
P
Thomas
R F
RF
Logan
D
D
Martin
M L
ML
Wilkinson
M
M
Lombard
D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010182:Pancreatic Diseases / Q000628:therapy*; D011446:Prospective Studies; D019233:Retreatment / Q000706:statistics & numerical data; D012307:Risk Factors; D017211:Treatment Failure; D006113:United Kingdom