Introduction Despite all the advances and improvement in ERCP techniques, post ERCP acute pancreatitis remains the most feared and common complication, being associated with high morbidity and mortality. The figures cited in literature vary from 1–7% to 12–31%. The pathogenesis of this condition is multifactorial and the severity of the condition may range from mild to severe pancreatitis. Most of the cases are of mild pancreatitis which usually resolves spontaneously without serious sequelae. The incidence of severe pancreatitis ranges from 0.3% to 0.6%.
The objective of our study was to look at the frequency of post ERCP pancreatitis in a setup, where ERCP accessories are reused because majority of the patients cannot afford the cost of new accessories for the procedure. Another objective was to look at the factors responsible for acute pancreatitis.
Methods This study was conducted at the endoscopy suite of surgical unit IV, Civil Hospital Karachi over a period of one year from 1st December 2010 to 30th November, 2011.
A total of 500 patients were included in the study. Patients who presented with pancreatitis or raised amylase levels pre procedure or patients who had previous history of surgery on the biliary or pancreatic systems were excluded from the study. Pearson Chi square and Fisher’s exact test were used for qualitative data and t-test for quantitative data. Significance was taken as p≤ 0.05. Odds ratio was calculated for the qualitative data using 95% confidence interval.
Results Age of the study population ranged from 9 to 90 years (mean age 46.5 years ±14.94, median 45 years). Male to female ratio was 1:1.87. Pancreatitis was seen in 18 patients (3.6%). Mild in 15(3%), moderate in 1(0.2%) and severe in 2(0.4%). Mean amylase level at 4 hours and 24 hours was 280.93±539.13 and 168.83 ± 338.34 respectively. Pancreatitis was seen in 15/326 (4.6%) female and 3/174 (1.72%) males. Statistically significant increased risk for pancreatitis was seen in difficult cannulation (9.8%, p = 0.006), prolonged cannulation time (7.6min, p = 0.002), pancreatic duct cannulation (13.7%, p = 0.001) and pancreatic duct contrast injection (13.4%, p < 0.001).
Conclusion The frequency of pancreatitis was comparable to that of international literature. Difficult cannulation, pancreatic duct cannulation, pancreatic duct contrast injection and balloon sphincteroplasty increases the incidence of post ERCP pancreatitis. Reuse of ERCP accessories poses no additional risk to the frequency of pancreatitis.
Disclosure of Interest None Declared.
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