Early Complications And Management Of ERCP With A Report Of 3350 Cases

Background and Objective:Through 40 years' development,the endoscopic retrograde cholangiopancreato-graphy (ERCP) has already been extensively utilized in the diagnosis and treatment of various biliary tract or pancreas diseases.It has been generally carried out in many large hospitals and proved to be a safe and effective technique.However,the risk,especially the postoperative complications of ERCP,is still the most attractive problem.With the extensive development of ERCP and the continual extension of endoscopic papillosphincterotomy(EST ) indication,the incidence of postoperative complications increased.The incidence of ERCP postoperative complications varied from 2%to 7%, and the mortality varied from 0.001%to 1.3%.ERCP was a micro-trauma or invasive technique for diagnosis or treatment.The incidence of complications was clinically unavoidable and most of the complications were not the results of physicians' negligence.How to prevent and reduce the incidence of complications was the key to carry out safely or effectively of ERCP.So we analyzed the occurrence of the early complications of ERCP and the management of diagnostic or therapeutic ERCP.Object and Methods:The clinical data of diagnostic or therapeutic ERCP of 3350 cases from TaiZhou Hospital,Zhejiang Province in 2000-2007 were summaried retrospectively.We analyzed the occurrence,the class,the management and the prognosis of the early complications of ERCP,and also analyzed the differences of the incidence of the complications between the diagnostic and therapeutic ERCP.Furthermore,the differences of the incidence of the hyperamylasemia and the acute pancreatitis were analyzed between two groups of patients who were treated with different prophylactic medication.Results:1.Among all of the 3350 cases tmdergoing diagnostic or therapeutic ERCP,68 cases were accompanied with the early complications(2.03%):26 cases of acute pancreatitis(0.78%),20 cases of massive hemorrhage of gastrointestinal tract(0.60%), 15 cases of cholangitis(0.45%),4 cases of perforation(0.12%),3 cases of aspiration pneumonitis(0.09%).All cases were successfully treated medically except one died and two were operated.2.The early complications of diagnostic or therapeutic ERCP occurred in 6(0.76%)and 62(2.42%) cases,respectively.Tthe incidence of acute pancreatitis was 0.63%and 0.82%,respectively.The incidence of massive hemorrhage of gastrointestinal tract was 0.13%and 0.74%,respectively.3.There was no significant difference of the incidence of hyperamylasemia and acute pancreatitis between two treatment groups.Conelutions.1.Acute pancreatitis was the most common early complications of the diagnostic or therapeutic ERCP.All these complications had been successfully treated expect one died.2.The incidence of early complications of therapeutic ERCP was higher than that of diagnostic ERCP.The most significant difference of the incidence was the massive hemorrhage of gastrointestinal tract,which was related to the extensive development of EST.3.Octreotide for postoperative preventive medication couldn't reduce the incidence of hyperamylasemia and acute pancreatitis.