Post-endoscopic retrograde cholangiopancreatography pancreatitis assessed using criteria for acute pancreatitis

Azumi Suzuki; Koji Uno; Kojiro Nakase; Koichiro Mandai; Bunji Endoh; Koki Chikugo; Takumi Kawakami; Takahiro Suzuki; Yoshitaka Nakai; Kiyonori Kusumoto; Yoshio Itokawa; Osamu Inatomi; Shigeki Bamba; Yoshinori Mizumoto; Kiyohito Tanaka

doi:10.1002/jgh3.12687

Post-endoscopic retrograde cholangiopancreatography pancreatitis assessed using criteria for acute pancreatitis

JGH Open. 2021 Dec 6;5(12):1391-1397. doi: 10.1002/jgh3.12687. eCollection 2021 Dec.

Authors

Azumi Suzuki^{1

2}, Koji Uno¹, Kojiro Nakase^{1

3}, Koichiro Mandai¹, Bunji Endoh⁴, Koki Chikugo^{4

5}, Takumi Kawakami^{6

7}, Takahiro Suzuki^{6

8}, Yoshitaka Nakai⁹, Kiyonori Kusumoto⁹, Yoshio Itokawa⁹, Osamu Inatomi¹⁰, Shigeki Bamba¹⁰, Yoshinori Mizumoto⁴, Kiyohito Tanaka¹

Affiliations

¹ Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan.
² Present address: Department of Gastroenterology Hamamatsu Medical Center Shizuoka Japan.
³ Present address: Department of Gastroenterology Kyoto Okamoto Memorial Hospital Kyoto Japan.
⁴ Department of Gastroenterology National Hospital Organization Kyoto Medical Center Kyoto Japan.
⁵ Present address: Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan.
⁶ Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Kyoto Japan.
⁷ Present address: Department of Gastroenterology Municipal Tsuruga Hospital Fukui Japan.
⁸ Present address: Suzuki Naika Iin Kyoto Japan.
⁹ Digestive Disease Center, Department of Gastroenterology and Hepatology Kyoto Katsura Hospital Kyoto Japan.
¹⁰ Division of Gastroenterology, Department of Medicine Shiga University of Medical Science Otsu Japan.

Abstract

Background and aim: International consensus on the definition and classification of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) has been reached. However, the diagnosis and severity of PEP are often assessed according to the diagnostic criteria and classification for acute pancreatitis (AP). This study determined the incidence, severity, and risk factors of PEP diagnosed according to the diagnostic criteria and classification for AP in a large cohort.

Methods: This prospective, multicenter, observational cohort study conducted at five high-volume centers included 1932 patients who underwent ERCP-related procedures. The incidence, severity, and risk factors for PEP were evaluated.

Results: PEP occurred in 142 patients (7.3%); it was mild in 117 patients (6.0%) and severe in 25 patients (1.3%). According to the Cotton criteria, PEP occurred in 87 patients (4.5%); it was mild in 54 patients (2.8%), moderate in 20 patients (1.0%), and severe in 13 patients (0.7%). In the multivariate analysis, female sex (odds ratio [OR] 2.239; 95% confidence interval [CI] 1.546-3.243), naïve papilla (OR 3.047; 95% CI 1.803-5.150), surgically-altered gastrointestinal anatomy (OR 2.538; 95% CI 1.342-4.802), procedure time after reaching the papilla (OR 1.009; 95% CI 1.001-1.017), pancreatic duct injection (OR 2.396; 95% CI 1.565-3.669), and intraductal ultrasonography (OR 1.641; 95% CI 1.024-2.629) were independent risk factors.

Conclusion: According to the diagnostic criteria and classification for AP, the incidence of PEP was higher than that according to the Cotton criteria and the severity of PEP tended to be severe.

Keywords: acute pancreatitis; cohort studies; endoscopic retrograde cholangiopancreatography; intraductal ultrasonography; post‐endoscopic retrograde cholangiopancreatography pancreatitis.