Risk factors for complications in endoscopic retrograde cholangiopancreatography in the treatment of main bile duct lithiasis

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is now the reference technique for the treatment of biliopancreatic disorders. These results have improved considerably with the growing experience of operators, and advances in the design of endoscopes and operating instruments. Nevertheless, this technique is not without complications. The aim of our work is to evaluate the complication rate of ERCP in the treatment of main bile duct (MBD) lithiasis, and to investigate the factors associated with their occurrence.

Methods This is a retrospective descriptive and analytical study including 1,048 patients who underwent ERCP for BVP lithiasis between January 2010 and August 2024. Factors associated with the occurrence of post-ERCP complications were studied by logistic regression analysis. Statistical analysis was performed using Jamovi version 2.4 software.

Results During the study period, a total of 1,048 ERCP procedures were performed for lithiasis, of which 634 (60.5%) were for simple lithiasis, 289 (27.6%) for bile duct impaction and 125 (11.9%) for large stones (over 15mm in diameter). The mean age of our patients was 58.91+/- 14.3 years, with extremes ranging from 19 to 98 years. Our series was predominantly female (59.7%), with a sex ratio (M/F) of 0.67. Clinically, 18.7% of patients presented with acute angiocholitis and 9.4% with acute pancreatitis. A periampullary diverticulum was found in 9.4% of cases (n=98). VBP stenosis was present in 6.5% of patients (n=68). The primary vacuity rate was 77.3%. However, additional maneuvers were used in 20.5% of cases. Complications were reported in 5.8% of cases (n=60), including hemorrhage in 4.5% (n=47), pancreatitis in 0.8% (n=8), angiocholitis in 0.2% (n=2), perforation in 0.1% (n=1) and dormia impaction in 0.2% (n=2). No deaths occurred as a result of our procedures. In multivariate analysis, adjusting for age, gender, presence of BPV stenosis, presence of a periampullary diverticulum, choledochal impaction, presence of a large stone, performance of endoscopic biliary sphincterotomy and additional maneuvers ; only the presence of a large stone (OR=5.9, CI (1.460- 23.875), p=0.013) and female gender (OR=1.867, CI (1.012-3.444), p=0.046) increased the risk of complications after ERCP.

Conclusions The rate of post-ERCP complications due to lithiasis in our retrospective series is similar to that reported in the literature. Our study suggests that female gender and the presence of a large BPV stone are associated with a high risk of post-ERCP complications.

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Artikel online veröffentlicht:
27. März 2025