Table 3

Risk factors for post-ERCP pancreatitis and outcome of patients undergoing endoscopic sphincterotomy (n = 23).

Patient

Gender

Age at presentation

SOD type

Follow-up (months)

No of ERCPs

Pancreatic duct injection at 1st ERCP

Pre-cut sphincterotomy at 1st ERCP

Outcome of 1st ERCP

Recurrence after 1st ERCP

Complication


1

Female

49

I

50

4a

Yes

No

No effect

No

2

Female

66

II

89

1

Yes

Yes

No effect

pancreatitis

3

Male

34

III

0

1

Yes

No

No effect

pancreatitis

4

Female

29

II

37

2b

No

No

Improvement

Yes

No

5

Female

36

I

16

2

Yes

Yes

Resolution

No

pancreatitis (1st ERCP)

6

Female

27

I

10

1

No

No

Improvement

No

No

7

Female

44

II

27

1

Yes

Yes

No effect

retroperitoneal perforation

8

Female

47

II

39

2c

Yes

No

No effect

pancreatitis (2nd ERCP)

9

Female

49

II

24

1

No

Yes

Resolution

No

No

10

Female

44

II

22

1

No

No

Improvement

No

No

11

Female

46

II

56

2d

No

No

No effect

No

12

Female

49

II

43

2e

No

No

No effect

No

13

Female

47

II

60

4f

No

No

No effect

No

14

Female

26

I

13

1

No

No

Resolution

No

No

15

Female

46

II

15

1

No

No

No effect

No

16

Female

52

II

34

2g

Yes

No

Improvement

Yes

No

17

Female

57

II

28

1

No

No

Improvement

Yes

pancreatitis

18

Female

67

II

35

1

No

No

Resolution

Yes

No

19

Female

55

II

49

4h

Yes

No

Resolution

Yes

No

20

Female

46

II

92

3i

No

No

Resolution

Yes

pancreatitis (1st ERCP)

21

Female

27

II

110

7j

No

No

Improvement

Yes

No

22

Female

29

I

35

3k

Yes

No

Improvement

Yes

pancreatitis (3rd ERCP)

23

Female

43

I

2

2

No

Yes

Improvement

Yes

pancreatitis (1st ERCP)


Conventional over-the-wire biliary sphincterotomy was performed in all patients. In some patients, pre-cut sphincterotomy was performed to obtain access to the common bile duct prior to conventional sphincterotomy. The pre-cut and conventional sphincterotomy were performed during the same procedure apart from patient no 5 and 23 in whom they were performed a few weeks apart from each other as access to the common bile duct was achieved on a subsequent procedure a few weeks after pre-cut sphincterotomy.

a2nd ERCP, sphincterotomy extended; 3rd ERCP, trial of stent; 4th ERCP, stent removal as it was ineffective

b2nd ERCP for pancreatic sphincter of Oddi manometry showing raised pressure, pancreatic sphincterotomy performed leading to symptom improvement

c2nd ERCP, sphincterotomy assessed to be inadequate and was widened with no effect on symptoms

d2nd ERCP showed patent sphincterotomy, no endotherapy performed

e2nd ERCP for pancreatic SOM but pancreatic duct cannulation failed

f2nd ERCP done as pancreatic duct appeared dilated on follow-up MRCP. Pancreatic orifice appeared stenosed. No endotherapy performed as pancreatic stent could not be inserted despite deep guide wire pancreatic duct cannulation; 3rd ERCP for repeat attempt to perform pancreatic sphincterotomy, instrument failure during procedure; 4th ERCP pancreatic stenting and pancreatic sphincterotomy achieved leading to improvement in symptoms

g2n ERCP for pancreatic SOM normal pancreatic pressure thus no endotherapy performed

h2nd ERCP showed re-stenosed biliary sphincterotomy, biliary stenting performed; 3rd ERCP cholangitis due to stent obstruction, re-stenting; 4th ERCP extended sphincterotomy

i2nd ERCP showed patent sphincterotomy, biliary stenting performed; 3rd ERCP removal of stent as ineffective

j2nd ERCP, patent sphincterotomy, biliary stenting which was effective; 3rd-7th ERCP stent changes until surgery (choledochojejunostomy)

k2nd ERCP done for pancreatic sphincter of Oddi manometry, raised pancreatic pressure found and pancreatic sphincterotomy performed with improvement in symptoms; 3rd ERCP done due to symptom recurrence showed patent sphincterotomies, referred for surgery (open transduodenal sphincteroplasty)

Kalaitzakis et al. BMC Gastroenterology 2010 10:124   doi:10.1186/1471-230X-10-124

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