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

OBJECTIVES: endoscopic retrograde cholangiopancreatography (ERCP) is a wide ly available endoscopic modality, that is not without risks, but is no long er limited to tertiary referral centers. We evaluated the procedure in term s of imaging success, overall therapeutic failure, complications and mortal ity. METHODS: this retrospective study ran from January 1992 to December 1997. T he following data were collected: 1) cannulation rate, 2) failure to obtain images of the duct, 3) type of ERCP, 4) overall therapeutic failure rate a nd stone extraction, 5) overall complication rate, 6) immediate complicatio ns, 7) late complications (within the first 30 days), and 8) mortality. RESULTS: of 425 ERCP procedures performed, all data for 393 were obtained a nd included in the analysis. The cannulation success was 94%. Failure to ob tain a suitable image occurred in 10%. ERCP was diagnostic in 60% and thera peutic in 40%. Sphincterotomy was performed in 83% of the patients. The the rapeutic 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%), perfor ation (0.3%) and cholangitis (0.8%). There was no difference in the frequen cy of severe pancreatitis between the types of ERCP procedure. Bleeding occ urred more frequently in sphincterotomy (p < 0.05). The overall mortality r ate 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 E RCP and sphincterotomy.