Therapeutic Indications for ERCP: A Retrospective Study in a Moroccan Center

Aims The aim of our work was to analyze the profiles of ERCP indications within a Moroccan center.

Methods This is a monocentric retrospective descriptive study, spread over a period of 6 years from January 2019 to June 2024, collecting all patients who had benefited from ERCP within a Hepato-Gastroenterology department.

Results A total of 793 patients were enrolled. The median age was 60 years (18-91) with a female predominance and a sex ratio M/F of 0.51. The initial clinical symptoms were as follows: cholestatic jaundice in 547 patients (69%), followed by hepatic colic in 206 patients (26%), and pancreatic pain in 40 cases (5%) [1] [2]. The indications for ERCP were mainly benign: lithiasis of the main bile duct LVBP in 426 cases (53.7%), fistulised liver hydatid cyst in 39 cases (4. 9%), traumatic biliary injuries in 24 patients (3%) (trauma to the bile ducts in 16 cases and stenosis of the choledoco-bulbar anastomosis in 8 cases), cholangitis in 8 patients (1%) (PSC in 3 cases and IGG4 DISEASE in 5 cases), portal cavernous cholangiopathy in 2 patients (0.25%) and extrinsic compression by tuberculosis nodes in one case (0.13%). Malignant pathology was adenocarcinoma of the head of the pancreas in 150 cases (18.9%), cholangiocarcinoma in 105 cases (13.2%) (perihilar CCK in 67 cases and Calculo Kc in 38 patients), degenerated ampulloma in 28 patients (3. 5%) and malignant extrinsic compression in 10 patients (1.3%) (compressive adenopathies in 4 cases, liver metastases in 6 cases and pancreatic lymphoma in one patient). Complications were noted in 5.6% of cases and were as follows: an angiocholitis- in 14 patients (1.8%), significant bleeding at the edges of the sphincterotomy requiring a haemostatic procedure in 20 patients (2.5%), acute pancreatitis post-ercp for biliary lithiasis in 9 patients (1.1%) and a single case of accidental passage of the guide wire in the portal trunk (0.12%). The outcome of the patients was favorable in all but one case, who died following septic shock (0.12%).

Conclusions ERCP is a cornerstone in the therapeutic management of biliopancreatic pathologies with a low morbidity and mortality rate. In our center, the indications are multiple and are mainly dominated by benign pathology, with lithiasis and complicated hydatid cysts of the liver at the top of the list.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Lee J.. et al. 'Clinical outcomes of ERCP in patients with hepatobiliary disease: A retrospective study.'. World Journal of Gastroenterology 2020; 26 (2): 187-198
• 2 Fritz J.. et al. 'Endoscopic retrograde cholangiopancreatography (ERCP): Current indications and techniques.'. Gastrointestinal Endoscopy 2018; 88 (3): 523-531