Diagnostic and therapeutic ERCP: a large single centre's experience

Background Most large published series on endoscopic retrograde cholangiopa ncreatography (ERCP) are multicentre-based and consequently reflect varying experience. Aims To assess morbidity and mortality rates of ERCP in a single tertiary r eferral centre, Methods A series of 1,758 consecutive ERCPs performed in 1,148 patients bet ween 1991 and 1994 were reviewed to evaluate indications, findings, procedu res, success, complication and mortality rates, Results There were 1,108 (63%) successful initial ERCPs, 11 % failed cannul ation attempts and 26% follow-up ERCPs. The desired duct was successfully c annulated in 96.5% of cases, Initial cannulation failure rate was 8.8%. Twe nty-seven per cent had normal ERCPs, 30% had choledocholithiasis and 22% ha d strictures, Fifty-five per cent had therapeutic ERCPs. Major complication s occurred in 3.5% with four ERCP-related deaths (0.35%). Therapeutic ERCP had a higher incidence of major complications compared to diagnostic ERCP: 4.6% vs 2.1 %, (p=0.02); and mortality rate was 0.5% vs 0.2%, (p=0.4). Sign ificant haemorrhage secondary to biliary sphincterotomy, pre-cut papillotom y and snare papillectomy accounted for most of the difference (1.6%). Conclusions The majority of ERCPs were performed in elderly patients, over half of whom required therapeutic ERCP. Therapeutic ERCP carried significan tly higher complication rate compared with diagnostic ERCP. Unsuccessful ca nnulation and follow-up ERCP accounted for 11 % and 26% of ERCP workload, r espectively.