RISK FACTORS FOR SUCCESS AND COMPLICATIONS AFTER ENDOSCOPIC SPHINCTEROTOMY FOR BILE DUCT STONES: A 17- YEAR EXPERIENCE WITH 2137 CASES

IDA Sanmartin; JC Pereira Lima; G Pereira Lima; IA Avila

doi:10.1055/s-0040-1704046

Endoscopy, Table of Contents

Endoscopy 2020; 52(S 01): S13
DOI: 10.1055/s-0040-1704046

ESGE Days 2020 oral presentations

Thursday, April 23, 2020 16:30 – 18:00 ERCP for biliary stones Liffey Hall 2

RISK FACTORS FOR SUCCESS AND COMPLICATIONS AFTER ENDOSCOPIC SPHINCTEROTOMY FOR BILE DUCT STONES: A 17- YEAR EXPERIENCE WITH 2137 CASES

IDA Sanmartin

¹Hospital Santa Casa de Misericordia de Porto Alegre, Gastroenterology and Endoscopy, Porto Alegre, Brazil

,

JC Pereira Lima

²Universidade federal de Ciências da Saúde de Porto Alegre, Endoscopy, Porto Alegre, Brazil

,

G Pereira Lima

³Hospital Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil

,

IA Avila

⁴Hospital Santa Inés, Cuenca, Ecuador

› Author Affiliations

Abstract

Full Text

Aims Risk factors for post-ERCP complications are well-studied. However, risk factors for complications and success after endoscopic sphicterotomy for stone management, the main indication of ERCP, are poorly-determined. The aim of this study is to verify risk factors for mortality, complications and success after sphincterotomy (EST)with attempted stone retrieval.

Methods A multivariate analysis was carried out in a prospectively collected dataset of ERCPs performed from 1997 to 2013.

Results A total of 5226 ERCPs were performed in 17 years, of which 2137 were in patients with bile duct stones (1458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications- acute pancreatitis in 87 (4.1%), bleeding, 48 (2.2%), cholangitis in 21. (1%), perforation in 7 (0.3%) and other complications in 8 (0.4%) cases, with mortality rate of 0.6%. Successful stone(s) removal was obtained in 2028 patients (94.9%). At clinical presentation, 6.5% (138) had cholangitis, 9.5% had acute pancreatitis (203). Pre-cut was performed in 191 cases (9.4%). On multivariate analysis,procedure-related mortality was associated with age > 60 yr. (1 vs. 0.2%), cholangitis (4.3 vs.0.3%) and EST–related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation(86.2 vs. 98.7%), precutting(79.4 vs. 96.4%) and pos-EST complications (86.5 vs. 95.6%).

Conclusions The main risk factors for complications after EST with attempted stone removal are delayed bile duct cannulation and failed stone retrieval. EST-associated mortality is higher in older patients,those who presented with an EST-related complication or those who presented initially with cholangitis. Difficult cannulation, EST-related complications and pre-cut were associated with an unsuccessful procedure. In this series,outpatient EST with attempted stone retrieval showed to be as safe as performing the procedure in hospitalized patients.