title: Complications of ERCP for choledocholithiasis in a sickle cell cohort.
abstract: BACKGROUND
  Patients with sickle cell disease (SCD) demand special attention during clinical interventions because they are predisposed to acute chest syndrome (ACS), vaso-occlusive crises, intra-vascular haemolysis and immune paresis. Although SCD is endemic in the Caribbean, there has been no report on endoscopic retrograde cholangio-pancreatography (ERCP) outcomes in these patients from this region.
  
  
  METHODS
  The records of patients with SCD who underwent ERCP between 1 January 2005 and 1 June 2010 were analysed retrospectively. Parameters assessed included patient demographics, procedural details, ERCP-related and SCD-related morbidity. Data were analysed using SPSS version 12.0.
  
  
  RESULTS
  Fifty-four patients with SCD were subjected to ERCP during the study period. There were 37 women and 17 men at a mean age of 28 years (SD +/-12.05). There was 29% (16) overall morbidity, with 10 (18.5%) SCD-related complications and six (11.1%) ERCP-specific complications. More common complications were: pancreatitis (9.3%); cholangitis (1.9%); ACS (9.3%); pneumonia (3.7%); and painful crises (5.6%). There was one death (1.9%) due to multiple organ failure secondary to severe pancreatitis.
  
  
  CONCLUSIONS
  This study suggests that the SCD cohort requires special perioperative attention to minimise the inordinately high morbidity, many of which are SCD-related. We propose a perioperative management protocol that may minimise morbidity in these patients.
authors.affiliation: Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago socawich@hotmail.com.
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.affiliation: Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica.
authors.forename: Milton
authors.initials: M
authors.lastname: Arthurs
authors.affiliation: Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica.
authors.forename: Trevor
authors.initials: T
authors.lastname: Murphy
authors.affiliation: Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago.
authors.forename: Kimon O
authors.initials: KO
authors.lastname: Bonadie
authors.affiliation: General Surgeon, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica.
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Roberts
authors.affiliation: Professor of Surgery, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago.
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D011014:Pneumonia; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014300:Trinidad and Tobago / Q000453:epidemiology
keywords: ERCP; acute chest syndrome; morbidity; pancreatitis; sickle cell disease