title: ERCP-related adverse events in patients with primary sclerosing cholangitis.
abstract: BACKGROUND
  ERCP is frequently used in patients with primary sclerosing cholangitis (PSC) for cancer surveillance and treatment of dominant strictures.
  
  
  OBJECTIVE
  To evaluate the prevalence and risk factors for ERCP-related adverse events in patients with PSC.
  
  
  METHODS
  Retrospective analysis of ERCPs performed from 1998 to 2012.
  
  
  METHODS
  Referral center.
  
  
  METHODS
  A total of 294 consecutive patients with PSC who underwent a total of 657 ERCPs.
  
  
  METHODS
  ERCP.
  
  
  METHODS
  ERCP-related adverse events and predictive factors were determined by univariate and multivariate analyses.
  
  
  RESULTS
  ERCP use in patients with PSC showed a significant increase during the second half of the study period (2006-2012) compared with the first half (1998-2005) (437 vs 220 procedures; P = .04). Primary cannulation was successful in 634 procedures (96.6%) or in 271 of 294 patients (92.2%). Access to the bile duct was achieved with a needle-knife in 19 procedures (2.9%), whereas ERCP was unsuccessful in 4 of 657 procedures (0.6%), and successful percutaneous drainage was performed. Post-ERCP pancreatitis (PEP) was diagnosed in 8 (1.2%), cholangitis in 16 (2.4%), and bleeding in 4 (0.7%) procedures. Overall, risk of any adverse event was 28 of 657 (4.3%) procedures. On multivariate analysis, performing biliary sphincterotomy (odds ratio [OR] 5.04; 95% confidence interval [CI], 2.01-12.60; P = .001) and passage of a guidewire into the pancreatic duct (OR 4.54; 95% CI, 1.44-14.30; P = .010) were independently associated with an increased risk of any adverse event.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Cholangitis appears to be the most common adverse event despite intraprocedural antibiotic use. There was a low risk of adverse events in patients with PSC undergoing ERCP.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Shishira
authors.initials: S
authors.lastname: Nayak
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Vennisvasanth
authors.initials: V
authors.lastname: Lourdusamy
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult