ERCP-related adverse events in patients with primary sclerosing cholangitis

BackgroundERCP is frequently used in patients with primary sclerosing cholangitis (PSC) for cancer surveillance and treatment of dominant strictures.ObjectiveTo evaluate the prevalence and risk factors for ERCP-related adverse events in patients with PSC.DesignRetrospective analysis of ERCPs performed from 1998 to 2012.SettingReferral center.PatientsA total of 294 consecutive patients with PSC who underwent a total of 657 ERCPs.InterventionsERCP.Main Outcome MeasurementsERCP-related adverse events and predictive factors were determined by univariate and multivariate analyses.ResultsERCP use in patients with PSC showed a significant increase during the second half of the study period (2006-2012) compared with the first half (1998-2005) (437 vs 220 procedures; P = .04). Primary cannulation was successful in 634 procedures (96.6%) or in 271 of 294 patients (92.2%). Access to the bile duct was achieved with a needle-knife in 19 procedures (2.9%), whereas ERCP was unsuccessful in 4 of 657 procedures (0.6%), and successful percutaneous drainage was performed. Post-ERCP pancreatitis (PEP) was diagnosed in 8 (1.2%), cholangitis in 16 (2.4%), and bleeding in 4 (0.7%) procedures. Overall, risk of any adverse event was 28 of 657 (4.3%) procedures. On multivariate analysis, performing biliary sphincterotomy (odds ratio [OR] 5.04; 95% confidence interval [CI], 2.01-12.60; P = .001) and passage of a guidewire into the pancreatic duct (OR 4.54; 95% CI, 1.44-14.30; P = .010) were independently associated with an increased risk of any adverse event.LimitationsRetrospective study.ConclusionCholangitis appears to be the most common adverse event despite intraprocedural antibiotic use. There was a low risk of adverse events in patients with PSC undergoing ERCP.