Risk Factors for Post-ERCP Pancreatitis in High-Risk Patients Receiving Post-procedure Rectal Indomethacin

• DOI: 10.1007/s11605-018-3864-0
• Publication Date: 2018-07-06T17:33:30Z
• Authors: Xiaoyu Kang; Liyue Zheng; Wei Zeng; Shengye Yang; Hao Sun; Rongchun Zhang; Xiangping Wang; Biaoluo Wang; Qin Tao; Shaowei Yao; Jie Chen; Yanglin Pan; Xuegang Guo
• Keywords: Adult; Cholangiopancreatography, Endoscopic Retrograde; Male; Postoperative Care; Cholestasis; Medical Errors; Anti-Inflammatory Agents, Non-Steroidal; Indomethacin; Contrast Media; Middle Aged; Catheterization; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Pancreatitis; Sphincter of Oddi Dysfunction; Administration, Rectal; Risk Factors; Humans; Female; Aged; Retrospective Studies

Post-ERCP pancreatitis (PEP) is the most common adverse event of ERCP. Rectal indomethacin has been widely administered to decrease the incidence of PEP in high-risk patients. However, it cannot completely prevent the occurrence of PEP. The purpose of the study was to evaluate the risk factors for PEP in high-risk patients receiving post-ERCP indomethacin.From June 2012 to July 2015, patients undergoing ERCP and at high risk for PEP in three tertiary hospitals in China were enrolled. All patients received indomethacin after the procedure. Patient-related and procedure-related risk factors for PEP were collected. Logistic regression analysis was used to investigate the risk factors.Seven hundred ninety patients at high risk for PEP received post-ERCP indomethacin. The incidence of overall PEP and moderate-to-severe PEP was 8.0 and 1.5%, respectively. In multivariate analysis, suspected sphincter of Oddi dysfunction (SOD) (OR 2.73; 95%CI 1.38-5.43; p = 0.004), the presence of hilar obstruction (OR 4.53; 95%CI 1.60-12.81; p = 0.004), number of cannulation attempts ≥ 13 (OR 2.00; 95%CI 1.07-3.77; p = 0.030), inadvertent pancreatic duct (PD) cannulation ≥ 1 (OR 2.26; 95%CI 1.04-4.90; p = 0.040), and pancreatic contrast injections ≥ 1 (OR 2.30; 95%CI 1.02-5.23; p = 0.046) were high risk factors for overall PEP. For moderate-to-severe PEP, suspected SOD (OR 4.67; 1.19-18.35; p = 0.027), the presence of hilar obstruction (OR 7.95; 1.39-44.97; p = 0.010), and more cannulation attempts (OR 3.71; 1.09-12.65; p = 0.036) were three independent risk factors.A substantial number of high-risk patients had PEP even receiving post-ERCP rectal indomethacin. The independent risk factors included suspected SOD, hilar stricture, more cannulation attempts, inadvertent PD cannulation, and PD contrast injections.NCT02709421.