Five-year analysis of endoscopic retrograde cholangiopancreatography in the Hospital del Bierzo.

OBJECTIVES: endoscopic retrograde cholangiopancreatography (ERCP) is a widely available endoscopic modality, that is not without risks, but is no longer limited to tertiary referral centers. We evaluated the procedure in terms of imaging success, overall therapeutic failure, complications and mortality. METHODS: this retrospective study ran from January 1992 to December 1997. The following data were collected: 1) cannulation rate, 2) failure to obtain images of the duct, 3) type of ERCP, 4) overall therapeutic failure rate and stone extraction, 5) overall complication rate, 6) immediate complications, 7) late complications (within the first 30 days), and 8) mortality. RESULTS: of 425 ERCP procedures performed, all data for 393 were obtained and included in the analysis. The cannulation success was 94%. Failure to obtain a suitable image occurred in 10%. ERCP was diagnostic in 60% and therapeutic in 40%. Sphincterotomy was performed in 83% of the patients. The therapeutic failure rate was 15%. Stone extraction was successful in 69%. The overall complication rate was 8.6%; 2.2% of these complications were severe or fatal. Immediate complications occurred in 4% and late complications in 5.9%. Immediate complications were less frequent in diagnostic ERCP (p < 0.01). Late complications were: pancreatitis (3. 5%), bleeding (1.4%), perforation (0.3%) and cholangitis (0.8%). There was no difference in the frequency of severe pancreatitis between the types of ERCP procedure. Bleeding occurred more frequently in sphincterotomy (p < 0.05). The overall mortality rate was 1.6%. CONCLUSIONS: a continuous audit in each endoscopy unit should be performed to improve ERCP procedures. Diagnostic and therapeutic ERCP carry a similar risk of severe pancreatitis. The bleeding rate was higher in therapeutic ERCP and sphincterotomy.