Outcomes of pancreatic therapeutic ERCP as compared with biliary therapeutic and diagnostic ERCP: A prospective multisite study

M. L. Freeman, D. B. Nelson, J. A. DiSario, C. S. Overby, R. V. Erickson, M. E. Ryan, G. S. Bochna, M. J. Shaw, J. P. Moore, H. W. Snady, M. B. Fennerty, J. G. Lee, A. M. Pheley

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Abstract

Endoscopic therapeutics on the pancreatic sphincter(s) and duct(s) (Pancr-Tx) are increasingly performed at tertiary centers, yet little is known of their utilization or outcomes in other settings. Methods: All consecutive ERCP's attempted at 11 centers (6 private, 5 university) were prospectively studied. Procedure data were recorded at time of ERCP and outcomes were assessed at 30 days. Complications were denned by established consensus criteria, and included indirect events. Intent-to-treat was considered a success only if sphincterotomy (ES), stone clearance, stricture drainage or other Tx of the intended duct(s) was total at first procedure. Results: Of 1,586 ERCP, intent was biliary Tx only in 1,019 (64%), Dx only in 341 (22%), and Pancr-Tx in 226 (14%). Intended Pancr-Tx comprised 22% of all ERCP at academic centers vs 5% in private practices. Intended Pancr-Tx included pancreatic stent insertion (n=167) and/or removal (n = 68), pancreatic ES of major (n=60) or minor papilla (n = 22), stricture dilation (n = 53), pancreatic stone extraction (n = 17), tissue sampling (n = 14), and other Tx (n = 14). Dx only n = 341 Biliary Tx n=1,019 Pancr-Tx n=226 % including ES 0% 65% bil ES 35% pancrES Success rate 90% 88% 85% Complications 6.5% 10.8% 24.8%*(Pancreatitis) (5.9%) (4.2%) (18.2%)*(Severe cpmpl'ns) (0.9%) (1.2%) (1.3%) ERCP-related hospital daysmean = 1.0 ± 0.1*mean = 1.6 ± 0.1 mean = 2.0 ± 0.3*P<0.05 versus others For ES, complication rates were 80/842 (9.5%) for Dx or Tx ERCP without ES, 79/666 (11.9%) with biliary ES, and 29/78 (37.2% )*with pancreatic ES (49 pancr ES and 29 combined pancr/bil ES). Conclusions: Pancreatic therapeutic ERCP is less successful, and has a significantly higher overall complication rate than purely diagnostic or biliary therapeutic ERCP, despite its performance primarily in specialized centers. Its effectiveness needs further study.

Original languageEnglish (US)
Pages (from-to)AB136
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - Dec 1 1998

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Freeman, M. L., Nelson, D. B., DiSario, J. A., Overby, C. S., Erickson, R. V., Ryan, M. E., Bochna, G. S., Shaw, M. J., Moore, J. P., Snady, H. W., Fennerty, M. B., Lee, J. G., & Pheley, A. M. (1998). Outcomes of pancreatic therapeutic ERCP as compared with biliary therapeutic and diagnostic ERCP: A prospective multisite study. Gastrointestinal endoscopy, 47(4), AB136.