Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital
<b>Background/Objectives</b>: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this st...
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2025-03-01
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| author | Matei-Alexandru Cozma Cristina Angelescu Andrei Haidar Radu Bogdan Mateescu Camelia Cristina Diaconu |
| author_facet | Matei-Alexandru Cozma Cristina Angelescu Andrei Haidar Radu Bogdan Mateescu Camelia Cristina Diaconu |
| author_sort | Matei-Alexandru Cozma |
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| description | <b>Background/Objectives</b>: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. <b>Methods</b>: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer’s solution after the procedure in the absence of contraindications, according to the latest international recommendations. <b>Results</b>: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, <i>p</i> < 0.001, main pancreatic duct catheterization, OR = 1.454, <i>p</i> = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, <i>p</i> < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (<i>p</i> < 0.001). <b>Conclusions</b>: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention. |
| format | Article |
| id | doaj-art-c03bf87be6fb479595ae3a5f5b33c1ba |
| institution | DOAJ |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-c03bf87be6fb479595ae3a5f5b33c1ba2025-08-20T02:42:39ZengMDPI AGBiomedicines2227-90592025-03-0113372710.3390/biomedicines13030727Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary HospitalMatei-Alexandru Cozma0Cristina Angelescu1Andrei Haidar2Radu Bogdan Mateescu3Camelia Cristina Diaconu4Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, RomaniaFaculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania<b>Background/Objectives</b>: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. <b>Methods</b>: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer’s solution after the procedure in the absence of contraindications, according to the latest international recommendations. <b>Results</b>: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, <i>p</i> < 0.001, main pancreatic duct catheterization, OR = 1.454, <i>p</i> = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, <i>p</i> < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (<i>p</i> < 0.001). <b>Conclusions</b>: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.https://www.mdpi.com/2227-9059/13/3/727post-ERCP pancreatitismain pancreatic duct cannulationendoscopic papillary balloon dilatation |
| spellingShingle | Matei-Alexandru Cozma Cristina Angelescu Andrei Haidar Radu Bogdan Mateescu Camelia Cristina Diaconu Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital Biomedicines post-ERCP pancreatitis main pancreatic duct cannulation endoscopic papillary balloon dilatation |
| title | Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital |
| title_full | Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital |
| title_fullStr | Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital |
| title_full_unstemmed | Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital |
| title_short | Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital |
| title_sort | incidence risk factors and prevention strategies for post ercp pancreatitis in patients with biliopancreatic disorders and acute cholangitis a study from a romanian tertiary hospital |
| topic | post-ERCP pancreatitis main pancreatic duct cannulation endoscopic papillary balloon dilatation |
| url | https://www.mdpi.com/2227-9059/13/3/727 |
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