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Diagnostic and therapeutic ERCP: a large single centre's experience.
R J Farrell1, N Mahmud, N Noonan
1Department of Medicine and Gastroenterology, Trinity College Dublin, St James's Hospital, Ireland. rfarrell@caregroup.harvard.ed
Irish Journal of Medical Science
|July 18, 2002
Summary
This study assessed endoscopic retrograde cholangiopancreatography (ERCP) outcomes in a single center. Therapeutic ERCP showed higher complication rates than diagnostic ERCP, highlighting the need for careful patient selection.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Endoscopic Procedures
Background:
- Published endoscopic retrograde cholangiopancreatography (ERCP) series often involve multiple centers, leading to variable experience.
- Assessing ERCP outcomes within a single, high-volume tertiary referral center provides a focused perspective on procedure safety and efficacy.
Purpose of the Study:
- To evaluate the morbidity and mortality rates associated with endoscopic retrograde cholangiopancreatography (ERCP).
- To analyze indications, findings, procedural success, and complication rates in a consecutive series of ERCPs.
Main Methods:
- Review of 1,758 consecutive ERCPs performed on 1,148 patients between 1991 and 1994.
- Evaluation of indications, procedural success rates, complication incidence, and mortality.
- Comparison of outcomes between diagnostic and therapeutic ERCP procedures.
Main Results:
- Successful initial ERCP was achieved in 63% of cases, with an overall duct cannulation success rate of 96.5%.
- Choledocholithiasis (30%) and strictures (22%) were common findings; 55% of procedures were therapeutic.
- Major complications occurred in 3.5% of ERCPs, including four deaths (0.35%). Therapeutic ERCP had a significantly higher complication rate (4.6%) versus diagnostic ERCP (2.1%).
Conclusions:
- Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in elderly patients, with over half requiring therapeutic interventions.
- Therapeutic ERCP is associated with a significantly higher risk of complications compared to diagnostic ERCP.
- Cannulation failure and the need for follow-up ERCP represent a notable portion of the overall ERCP workload.