Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study☆,☆☆,★,★★
Section snippets
PATIENTS AND METHODS
As a part of a program of quality assurance, a prospective study on major ERCP complications was carried out from February 1, 1992, to January 31, 1994, under the auspices of the Triveneto Section of the Italian Society for Digestive Endoscopy. Triveneto includes three economically and socially developed regions in northeast Italy: Veneto, Trentino Alto Adige, and Friuli Venezia Giulia, with about 100 public general hospitals serving a population of 6,534,626 and at least 30 endoscopy units
RESULTS
The number of candidate-independent patients undergoing ERCP in single units ranged from 45 to 449 per year and ERCPs were performed either by a single operator or by a team of no more than three endoscopists. Three centers performed ERCP on less than 100 patients per year (range 45 to 78), three between 100 and 150 (range 127 to 148), and three on more than 200 (range 203 to 449). For purposes of comparative analysis, the last three were named large centers, and the other six were named small
DISCUSSION
Most studies on ERCP complications have been specifically devoted to sphincterotomy, the highest risk procedure routinely performed by endoscopists, whereas data on diagnostic ERCP are limited. A large retrospective U.S. survey by Male et al.9 did not find a statistically significant difference between diagnostic and therapeutic ERCP in the incidence of severe complications and in mortality. A different finding resulted from a British survey involving ten centers in a single region,10 where
Acknowledgements
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Acknowledgements
We thank Professor Nib Soehendra, University Hospital of Hamburg (Germany), and Professor Lajos Okolicsanyi, Chair of Gastroenterology, University of Parma (Italy), for helpful discussion and advice.
References (40)
- et al.
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
(1991) Complications related to diagnostic and therapeutic endoscopic retrograde cholangiopancreatography
Gastrointest Endosc Clin N Am
(1996)- et al.
ERCP induced acute pancreatitis: risk assessment based on diagnostic and specific therapeutic cases [abstract]
Gastrointest Endosc
(1996) - et al.
Prospective study of post-ERCP complications following diagnostic and therapeutic ERCP [abstract]
Gastrointest Endosc
(1996) - et al.
Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography
Gastroenterology
(1996) - et al.
ERCP sphincterotomy practice: a prospective multicenter study [abstract]
Gastrointest Endosc
(1996) - et al.
Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve bile duct cannulation
Gastrointest Endosc
(1996) - et al.
The needle-knife: a valuable tool in diagnostic and therapeutic ERCP
Gastrointest Endosc
(1989) A prospective assessment of results for needle knife papillotomy and standard endoscopic sphincterotomy
Gastrointest Endosc
(1995)- et al.
The precut-technique is a safe procedure and does not increase the overall complication risk of sphincterotomy [abstract]
Gastrointest Endosc
(1995)
Needle knife papillotomy for endoscopic sphincterotomy and cholangiography
Gastrointest Endosc
Surgical management of complications of endoscopic sphincterotomy with precut papillotomy
Am J Surg
Diagnostic and therapeutic ERCP in the very old: safe with a high success rate [abstract]
Gastrointest Endoscopy
Biliary endoscopy in nonagerians—“ERCP in the nineties” [abstract]
Gastrointest Endoscopy
Complications of endoscopic sphincterotomy. A prospective series with emphasis on increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts
Gastroenterology
Pure cut electrocautery current for sphincterotomy causes less post-procedure pancreatitis than blended current [abstract]
Gastrointest Endosc
The risk of bleeding after endoscopic biliary sphincterotomy in patients with peri-ampullary diverticula: a prospective trial [abstract]
Gastrointest Endoscopy
Acute cholecystitis after palliative stenting for malignant obstruction of the biliary tree
Gastrointest Endosc
Acute cholecystitis after stenting of the common bile duct for obstruction secondary to pancreatic cancer
Gastrointest Endoscopy
Endoscopic cannulation of the ampulla of Vater: a preliminary report
Ann Surg
Cited by (0)
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From the S.I.E.D. (Italian Society for Digestive Endoscopy) Triveneto Study Group on ERCP Complications: Ospedali di Treviso, Verona (Policlinico e Maggiore) , Bolzano, Belluno, Pordenone, Trento, Noale (Padua), Villafranca (Verona), and Glaxo Wellcome Research Center, Verona, Italy.
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Supported in part by a grant from the Triveneto Section of the Italian Society for Digestive Endoscopy.
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Reprint requests: Silvano Loperfido, MD, Servizio di Gastroenterologia, ed Endoscopia Digestiva, Ospedale ULSS 9, 31100 Treviso, Italy.
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