title: Risk factors for complications of ERCP in primary sclerosing cholangitis.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiographic pancreatography (ERCP) is the most accurate technique for surveillance of patients with primary sclerosing cholangitis (PSC). Our aim was to evaluate risk factors for complications of ERCP in patients with PSC.
  
  
  METHODS
  In 2007 - 2009 we performed 441 ERCPs in patients with PSC. The primary tools for ERCP were a guide wire and papillotomy knife to gain access into the biliary duct. If the primary cannulation failed, and the wire went only into the pancreatic duct, pancreatic sphincterotomy was performed. If necessary, a further oblique cut with a needle knife was done in order to expose the biliary duct.
  
  
  RESULTS
  Primary cannulation was successful in 389 patients (88.2 %). Of these, 147 (37.8 %) had had biliary sphincterotomy performed previously. In the group with failed primary cannulation, access into the biliary duct was achieved after pancreatic sphincterotomy in 52 patients. In 11 of these, a further cut with a needle knife was performed. Post-ERCP pancreatitis (PEP) was diagnosed in 31 patients (7.0 %). Factors predicting PEP were female sex (odds ratio [OR] 2.6, P = 0.015) and a guide wire in the pancreatic duct (OR 8.2, P < 0.01). Previous biliary sphincterotomy was a protective factor (OR 0.28, P = 0.02). The risk of PEP increased with the number of times the wire accidentally passed into the pancreatic duct (P < 0.001). Cholangitis developed in 6 patients (1.4 %).
  
  
  CONCLUSIONS
  In patients with PSC the incidence of ERCP complications remained relatively low. The complication risk increased with the complexity of cannulation. In a patient with PSC in whom follow-up ERCP is planned, biliary sphincterotomy should be considered, as it may protect against PEP.
authors.affiliation: Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Ismail
authors.forename: L
authors.initials: L
authors.lastname: Kylänpää
authors.forename: H
authors.initials: H
authors.lastname: Mustonen
authors.forename: J
authors.initials: J
authors.lastname: Halttunen
authors.forename: O
authors.initials: O
authors.lastname: Lindström
authors.forename: K
authors.initials: K
authors.lastname: Jokelainen
authors.forename: M
authors.initials: M
authors.lastname: Udd
authors.forename: M
authors.initials: M
authors.lastname: Färkkilä
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome