Prospective risk assessment of endoscopic retrograde cholangiography in patients with primary sclerosing cholangitis

Background and Study Aims: Direct endoscopic retrograde cholangiopancreatog raphy (ERCP) has become the standard for establishing the diagnosis of prim ary sclerosing cholangitis (PSC), while endoscopic procedures play an incre asingly important therapeutic role. However, many believe that this procedu re carries a significant risk of infection and other complications. We asse ssed the incidence of complications within 1 week of ERCP in patients with PSC, Patients and Methods: In a multicenter study, patients who underwent ERCP f or (suspected) PSC were prospectively followed for the occurrence of compli cations after the procedure. Results: A total of 106 ERCPs performed in 83 patients were evaluated. Comp lications occurred on ten occasions (9%): pancreatitis (n=3), cholangitis ( n=2), increase of cholestasis (n=2), postsphincterotomy bleeding (n=1), cys tic duct perforation (n=1), and venous thrombosis (n=1), All complications resolved quickly with proper therapy. Complications were more likely when E RCP was done to evaluate specific complaints such as jaundice or recurrent cholangitis (9/59) than after a purely diagnostic ERCP (1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to 153), Therapeutic interventi ons performed during ERCP (e.g. placement of endoprosthesis, dilation of st rictures) also increased the risk of postprocedural complications (RR 4.5, 95% CI 0.94 to 30). Conclusion: ERCP is a safe method for establishing the diagnosis of PSC in asymptomatic patients (2 % complication rate). Although ERCP in symptomatic patients carries a higher risk (14 %), this can be justified by the benefi ts of endoscopic therapy.