title: Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort.
abstract: OBJECTIVE
  To determine utilisation of endoscopic retrograde cholangiopancreatography (ERCP); incidence of inpatient admissions for complications occurring within 30 days of ERCP and risk factors for procedural-related complications, in a population-based study.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Olmsted County, Minnesota.
  
  
  METHODS
  All adult residents of Olmsted County, Minnesota, who underwent ERCP from 1997 to 2006.
  
  
  METHODS
  Diagnostic and therapeutic ERCPs were assessed.
  
  
  METHODS
  Patient and procedural characteristics and complications within 30 days; and rates of ERCP utilisation and unplanned admissions and risk factors for admissions.
  
  
  RESULTS
  In 10 years, 1072 ERCPs were performed on 827 individual patients. Average utilisation of ERCP was 83.1 ERCPs/100 000 persons/year, with an increase from 58 to 104.8 ERCPs/100 000 persons/year over time, driven by increases in therapeutic procedures. Within 30 days after 236 procedures, 62 admissions were definitely related to the index ERCP. The complication rate was 5.3%, including pancreatitis (26, 2.4%), infection/cholangitis (16, 1.5%), bleeding (15, 1.4%) and perforation (4, 0.37%). 30-day mortality was 2.4%, none of which was directly related to the ERCP or complications thereof. Risk factors identified through multivariate analysis to be associated with adverse events included: age <45 years (p=0.0498); body mass index ≥35 (p=0.0024); pancreatic duct cannulation (p=0.0026); outpatient procedure (p<0.0001); intraprocedure sphincterotomy bleeding (p<0.0001); difficulty grade (p=0.115) and patient's first ERCP (p=0.0394).
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Population utilisation of ERCP rose during the study period, specifically in therapeutic procedures. Admissions within 30 days of ERCP are common but often unrelated. Complications of ERCP remain infrequent and deaths quite unusual.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Nayantara
authors.initials: N
authors.lastname: Coelho-Prabhu
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Holly
authors.initials: H
authors.lastname: Van Houten
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron