Endoscopic retrograde cholangiopancreatography complications in the era of cholangioscopy: is there an increased risk?
BACKGROUND
Single-operator cholangioscopy allows direct visualization of the biliary tree and is being used in the diagnosis and treatment of various biliary conditions. To date, there are few data examining complications of single-operator cholangioscopy.


METHODS
We evaluated all endoscopic retrograde cholangiopancreatography procedures over a two-year period and compared its complication rate to single-operator cholangioscopy in a tertiary care centre with extensive experience in single-operator cholangioscopy. A total of 2087 patients (55% men, mean age 57.4±16.4) had a therapeutic endoscopic retrograde cholangiopancreatography, out of which 169 also had single-operator cholangioscopy performed on them.


RESULTS
169 single-operator cholangioscopy procedures were performed (53% men) with a mean patient age of 60.7±15.2 years. Out of the 2087 patients, 160 complications occurred (7.7%), and included pancreatitis (n=47, 2.2%), infection (n=24, 1.1%), bleeding (n=44, 2.1%), perforation (n=16, 0.8%) and other (n=29, 1.4%). Univariate analysis on overall complications identified seven variables with a p value<0.2, which were included in the multivariate analysis. Biliary sphincterotomy, pancreatic duct stent placement, and ampullectomy were associated with increased complications. Single-operator cholangioscopy was not associated with increased complications on multivariate analysis.


CONCLUSIONS
Single-operator cholangioscopy is not associated with an increased rate of complications when compared to endoscopic retrograde cholangiopancreatography. The types and frequencies of overall endoscopic retrograde cholangiopancreatography complications are similar to previously reported series.
University of Virginia, Digestive Health Center, Charlottesville, VA, United States.
Christopher W
CW
Hammerle
Shahzad
S
Haider
Matthew
M
Chung
Ambarish
A
Pandey
Ioana
I
Smith
Michel
M
Kahaleh
Bryan G
BG
Sauer
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D016001:Confidence Intervals; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology*; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects