Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors

Pancreatitis and hyperamylasaemia are common complications of ERCP and this study was designed to explain which operative and patient factors predispose to them.

A 1 year prospective study of consecutive patients in a single operator centre with detailed attention to technical factors and the findings.

Four hundred and thirty ERCPs were performed. Pancreatitis occurred in 12 cases (2.8%). Amylase results were available in 407 cases; 17 were excluded because of pre-operative hyperamylasaemia (n = 5) and because of pancreatitis (n = 12). Of the remaining 390, 30 (7.7%) had hyperamylasaemia. Pancreatitis and hyperamylasaemia usually occurred after difficult procedures in which pancreatography was achieved. Smaller common bile-ducts, pre-cut papillotomy and some preoperative indications also significantly increased the risk of pancreatitis, while prior papillotomy was protective. Pancreatitis occurred in patients with a younger median age (52.5 vs 68.0; P < 0.05) and was more common in women (F:M = 11:1 vs 241:177; P < 0.05).

Operative factors are, in part, responsible for the development of pancreatitis and hyperamylasaemia but the age and sex of the patient also appear to be important.