Analysis Of Risk Factors For Post-ERCP Pancreatitis And Hyperamylasemia

Objective: To study the risk factor for acute pancreatitis and hyperamylasemia of postoperative endoscopic retrograde cholangiopacreatograph(Post – ERCP) complications.Methods: Clinical data of the 623 patients underwent ERCP in the gastroenterology of the first Affiliated Hospital of Wannan Medical College between Jan. 2014 and Nov. 2014 were retrospectively analyzed.According to the inclusion criteria,21 cases were eliminated and 612(male:female=265:347)cases were analyzed.Designed forms and recorded the patient’s age, gender, history of pancreatitis, hypertension, diabetes, cholecystectomy, and the patient’s preoperative serum amylase, lipase, serum bilirubin, abdominal ultrasound, abdominal computed tomography(CT) and magnetic resonance imaging(MRCP) and other test results, and viewed the patient’s surgical records,progress notes, ERCP’s operative time, intubation times, the developing times of pancreatic duct, common bile duct diameter, the calculous number and size, calculuses whether depletion, intraoperative diagnosis, and the situation of the postoperative hyperamylasemia and acute pancreatitis.Post-ERCP pancreatitis(PEP) and hyperamylasemia of 17 kinds of possible risk factors: age(< 60 years old), gender(female), history of cholecystectomy,pancreatitis, hypertension and diabetes, periampullary diverticulum, serum bilirubin(> 17.1μmol/L), common bile duct(> 1 cm) and difficult intubation, operation time(> 1 h), EST,ENBD,EPBD, the development of the pancreatic duct, not completely taking out calculuses, biliary stents and so on carried on the single factor analysis. The meaningful variable in the single factor analysis were furtherly studied by binary logistic multi-factor regression analysis, P < 0.05, showed statistically significant difference. Independent risk factors were actively looked for pancreatitis and hyperamylasemia of post-ERCP.Results: 612 patients who meet the inclusion critiria occurred PEP in the 38 cases, the incidence rate is 6.21%; hyperamylasemia of postoperative ERCP was 99 cases, rate of 16.18%.Single factor analysis showed that high blood pressure, no common bile duct expansion, difficult intubation, long operation time, the development of the pancreatic duct, not completely taking out calculuses as a risk factor for the PEP, but ENBD for the protection factors;and gender, age, history of pancreatitis, the history of cholecystectomy, diabetes history, elevated serum bilirubin(> 17.1 umol/L), periampullary diverticulum, EST and EPBD, bile duct stenting are not risk factor for PEP. At the same time, single factor analysis showed that periampullary diverticulum, no common bile duct expansion, difficult intubation, long operation time(> 1 h), the development of the pancreatic duct, and not completely taking out calculuses were risk factor for hyperamylasemia after ERCP, however ENBD was the protection factors;and gender, age, and history of pancreatitis, the history of cholecystectomy, hypertension, diabetes history, elevated serum bilirubin(> 17.1 umol/L), EST,EPBD and bile duct stenting were not risk factor for hyperamylasemia of post-ERCP. Multi-factor analysis displayed that high blood pressure, long operation time(> 1 h), not completely taking out calculuses, difficult intubation, the development of the pancreatic duct were independent risk factors for PEP, however ENBD was the protection factors; meanwhile showed not completely taking out calculuses, the development of the pancreatic duct, difficult intubation, no common bile duct expansion were independent risk factors for hyperamylasemia of post-ERCP,however ENBD was the protection factors.Conclusion: Hypertension, difficult intubation, long operation time(> 1 h), the development of pancreatic duct, not completely taking out calculuses and so on can trigger PEP. Futher analysis can display that hypertension, long operation time(> 1 h),not completely taking out calculuses,difficult intubation, the development of pancreatic duct and so on are independent risk factors incurred PEP,but ENBD is positive factors prevented PEP. Periampullary diverticulum, no common bile duct expansion and difficult intubation, long operation time(> 1 h), the development of pancreatic duct, not completely taking out calculuses can cause hyperamylasemia of post-ERCP, among not completely taking out calculuses, the development of pancreatic duct, difficult intubation, no common bile duct expansion were independent risk factors for hyperamylasemia of post-ERCP, however ENBD is protective factors for hyperamylasemia. Through the medical records analysis,we found that many factors can give rise to PEP and hyperamylasemia of post-ERCP, mastering these factors for reducing the incidence of PEP and hyperamylasemia is very important.We should strictly grasp the ERCP indications and contraindications, be familiar with ERCP technical operation, control preoperative blood pressure, reduce the operation time, lower the number of intubation, avoid the pancreatic duct development,adopt ENBD for postoperative can effectively reduce the incidence of PEP and hyperamylasemia of post-ERCP.