Post ERCP pancreatitis: Does acinarization or repeated pancreatic duct (PD) injections increase the risk — A prospective study

Gastrointestinal Endoscopy (Impact Factor: 5.37). 04/1997; 45(4). DOI: 10.1016/S0016-5107(97)80551-2


The most frequent complication of ERCP is pancreatitis occurring in 3-10% of pts. Potential risks associated with post ERCP pancreatitis are the number of PD injections and acinarization of the parenchyma. AIM: To determine whether the number of PD injections or parenchymal acinarization increases the risk of post ERCP pancreatitis. METHODS: We prospectively evaluated 330 consecutive pts undergoing both diagnostic and therapeutic ERCP (119 male, 211 female; average age 50.8 years). PD injections were not performed in 81 pts and these were excluded as were 53 pts with chronic pancreatitis. Thus, 196 pts were evaluated for post ERCP pancreatitis. Post ERCP pancreatitis was defined as having abdominal pain necessitating narcotics, a two-fold elevation in amylase and an extra day stay in the hospital after ERCP. The number of PD injections and acinarization of the parenchyma were recorded. RESULTS: Nine out of 196 pts developed post ERCP pancreatitis (4.6%). Twelve pts had acinarization during ERCP, but none of these developed pancreatitis. The number of injections in all pts ranged from 1 to 8. Those developing pancreatitis had 3 or less PD injections. Of the 9 pts who developed pancreatitis, only 1 had diagnostic ERCP. The frequency of complex procedures were similar in the group who did not develop pancreatitis. Factors Possibly Influencing Post-ERCP Pancreatitis PD INJECTIONS (n) PANCREATITIS ACINARIZATION 1-3 4-8 YES 9 0 0 NO 131 56 12 CONCLUSION: The number of PD injections and parenchymal acinarization does not correlate with post ERCP pancreatitis in this group. However, none of the pts in this study had greater than 8 PD injections. We suspect that post ERCP pancreatitis is multifactorial and unrelated to the number of PD injections and parenchymal acinarization.

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