title: Early repeat endoscopic retrograde cholangiopancreatography: predictive factors and interventions required.
abstract: OBJECTIVE
  Early repeat endoscopic retrograde cholangiopancreatography may be required due to various conditions in patients who underwent planned endoscopic retrograde cholangiopancreatography. We aimed to assess the factors leading to early repeat endoscopic retrograde cholangiopancreatography and to determine the patients who need closer follow-up.
  
  
  METHODS
  A total of 691 patients with a mean age of 60.3±16.4 years who had naive papilla on endoscopic retrograde cholangiopancreatography were involved in the study. The patients who required repeat endoscopic retrograde cholangiopancreatography were identified. Presentations, predictive factors, treatment modalities, and outcomes of the patients were investigated.
  
  
  RESULTS
  Early repeat endoscopic retrograde cholangiopancreatography was needed in 19 (2.7%) patients. The most common presentation was cholangitis in 10 (52.6%) and unresolved jaundice in 4 (21.1%). Multivariate analysis identified biliary stricture (p=0.024), stricture at the hilus (p=0.005) and unilateral drainage in the presence of hilar stricture (p=0.017) as the independent risk factors for early repeat endoscopic retrograde cholangiopancreatography. Stent migration or dysfunction was the most common underlying cause. Therapeutic interventions were nasobiliary drainage in 13, stent exchange in 4 and stone removal in 2. Additionally, percutaneous drainage in 4 patients, drainage of abscess in 2 patients and percutaneous drainage of gallbladder in 1 patient were performed. Three patients died due to their underlying illness.
  
  
  CONCLUSIONS
  Unilateral stenting especially in hilar strictures is a predictive factor for early repeat endoscopic retrograde cholangiopancreatography with high mortality. These patients should be under close follow-up.
authors.affiliation: Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology, 06100 Ankara, Turkey. drerkanparlak@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Cem
authors.initials: C
authors.lastname: Cengız
authors.forename: Selçuk
authors.initials: S
authors.lastname: Dışıbeyaz
authors.forename: Bahattin
authors.initials: B
authors.lastname: Çıçek
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Özın
authors.forename: Sabite
authors.initials: S
authors.lastname: Kacar
authors.forename: Nurgül
authors.initials: N
authors.lastname: Şaşmaz
authors.forename: Burhan
authors.initials: B
authors.lastname: Şahın
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000601:surgery; D002764:Cholecystitis / Q000601:surgery; D003085:Colic / Q000601:surgery*; D016001:Confidence Intervals; D003251:Constriction, Pathologic / Q000150:complications / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D007565:Jaundice / Q000601:surgery; D008100:Liver Abscess / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011475:Prosthesis Failure / Q000009:adverse effects; D011537:Pruritus / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013997:Time Factors