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Infectious complications of endoscopic retrograde cholangio-pancreatography managed in a surgical unit
D Benchimol1, J L Bernard, J Mouroux
1Service de Chirurgie Abdominale et Thoracique, Hôpital Pasteur, Nice, France.
Abstract:
The immediate infectious pancreato-biliary complications of endoscopic retrograde cholangiopancreatography (ERCP) warranting transfer to a surgical unit are analyzed, in order to evaluate their frequency and severity as well as means of treatment and prevention. Thirty complications of this type were observed in a series of 3226 ERCP performed with or without endoscopic sphincterotomy (ES) over a six year period (0.9%). ES had been performed in 12 of 30 cases, but the complication could not be attributed to the procedure. Post-ERCP complications included: acute cholangitis: 16 cases (53%); acute cholecystitis: 8 cases (26%); acute pancreatitis: 4 cases (13%); infected pancreatic pseudocyst: 2 cases (6%). The global mortality rate was 16.6% (five patients): Four of the deaths were due to septic complications. Twenty-seven of the 30 patients underwent surgery, and three of them died (11%). Acute cholangitis was responsible for most of the deaths (four of five) and the mortality appeared related to the long interval before surgery (three of four deaths). Strict adherence to good endoscopic procedures (aseptic conditions, injection without excessive pressure, antibiotic prophylaxis) and decompression of the biliary tract (nasobiliary drain or transhepatic catheter) should help reduce the frequency of post-ERCP complications, and especially cholangitis, which appears to benefit from early surgical treatment.
Insights
Immediate infectious complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare but serious. Prompt surgical intervention for acute cholangitis may reduce mortality from these ERCP complications.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure for diagnosing and treating biliary and pancreatic diseases.
- Infectious complications can arise post-ERCP, necessitating transfer to a surgical unit for management.
- Understanding the frequency, severity, and outcomes of these complications is crucial for improving patient care.
Purpose of the Study:
- To analyze the immediate infectious complications following ERCP that require surgical intervention.
- To evaluate the frequency, severity, treatment, and prevention strategies for these post-ERCP complications.
Main Methods:
- Retrospective analysis of 3226 ERCP procedures performed over a six-year period.
- Identification and categorization of immediate infectious complications requiring transfer to a surgical unit.
- Review of treatment modalities and patient outcomes, including mortality rates.
Main Results:
- Thirty infectious complications (0.9%) were observed post-ERCP.
- The most frequent complications were acute cholangitis (53%), acute cholecystitis (26%), acute pancreatitis (13%), and infected pancreatic pseudocyst (6%).
- The overall mortality rate was 16.6%, with septic complications contributing significantly. Surgery was performed in 27 patients, with a 11% mortality rate among them.
Conclusions:
- Immediate infectious complications post-ERCP, particularly acute cholangitis, pose a significant risk.
- Adherence to proper endoscopic techniques, antibiotic prophylaxis, and biliary decompression can reduce complication rates.
- Early surgical treatment for acute cholangitis appears to improve outcomes and reduce mortality.