Endoscopic retrograde cholangiopancreatography-related pancreatitis and cholangitis differ according to biliary stricture anatomy: a cohort study.

OBJECTIVE

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and cholangitis are common complications. We evaluated whether stricture anatomy affects ERCP-related complications in patients with biliary strictures.

METHODS

From a prospectively maintained ERCP database, 1333 procedures with biliary strictures were screened. Patients with prior sphincterotomy, acute gallstone pancreatitis, chronic pancreatitis, postsurgical biliary strictures, or periampullary adenomas or carcinomas were excluded. Epidemiological, clinical, laboratory, radiological, and therapeutic data, as well as post-ERCP follow-up information, were collected.

RESULTS

In total, 789 patients were included (M/F: 53.1%/46.9%; mean age: 71 ± 13). Low strictures were observed in 490 (61.2%), while middle/high strictures were observed in 299 (38.8%). A pancreatic mass was documented in imaging 43%. Overall complications were higher in patients with middle/high versus low strictures (12.4% vs. 5.1%; P < 0.001) as also the PEP rate (5% vs. 1%; P < 0.001) and cholangitis rate (4.7% vs. 1.2%; P = 0.003). On multivariate analysis, stricture type independently predicted PEP [OR = 5.439; 95% confidence interval (CI) = 1.929-15.341; P = 0.001], while pancreatic mass was protective for PEP development (RR = 0.220; 95% CI = 0.063-0.762; P = 0.007). Middle/high strictures (OR = 3.965; 95% CI = 1.486-10.580; P = 0.006) and male sex (OR = 2.894; 95% CI = 1.031-8.119; P = 0.044) were independently correlated with cholangitis.

CONCLUSION

ERCP-related PEP and cholangitis in biliary strictures are strongly determined by stricture anatomy. Distal strictures - often associated with pancreatic mass - have significantly lower rates of PEP and cholangitis compared with middle/high strictures.