Risk Factors and Techniques Affecting Surgical Outcome of Therapeutic Endoscopic Retrograde Cholangiopancreatography Difficulties
Theerawood Gomutbutra, MD*
Affiliation : * Department of Surgery, Nakornping Hospital, Chiang Mai
Objective : To analyze the therapeutic endoscopic retrograde cholangio pancreatography (ERCP) difficulties
and complications experienced by a general surgeon and identify risk factors and technique affecting surgical
outcome.
Materials and Methods : A retrospective review was carried out in 88 consecutive ERCP operated with four
different indications on patients in Nakornping General Hospital by a surgeon trained from Nippon Medical
School, Japan.
Results : The patients average age was 57.2 years. Fifty-four patients had common bile duct stone and 43 of
them were successfully removed. Endoscopic sphincterotomy (EST) was the most frequent procedure needed
to combine with the stone extraction(23 in 43). Twenty-two distal common bile duct obstructions unable to
be diagnosed by ultrasound or computed tomography were operated on and found to be unvarying propor-
tion of tumor, stone or stricture. Among these 6 biopsy and 12 treatments were concurrently made. Eight bile
fistula and four cholangitis were indicated for endoscopic drainage. Only one serious bleeding was compli-
cated. Two perforations were discovered in the present series and none required laparotomy repair of
duodenum. Eighteen of the 88 failed to be operated on and most of them were within first four-month learning
curve. Duodenal diverticulum was a common failure factor. The pre-procedure unknown diagnosis relates to
an insignificant risk 2.4 times complications of the known (RR = 2.4, p = 0.31). Three patients (3.4%), all
over 70 years old, succumbed late after ERCP due to sepsis and myocardial infarction, compared to those
age under 70 is a significant risk factor (p = 0.059). Age over 50 seems to result in a higher pancreatitis
complication (3 versus none under 50) but not statistically significant (p = 0.405).
Conclusion : Skill and synchronous assistance are important factors for success of ERCP but a more unpre-
dictable outcome and complications were encountered for the preoperative undiagnosable obstructive
jaundice. Hot and slow sphincterotomy would minimize the bleeding complication. Duodenal diverticulum
and those operated on for late obstruction were risk factors in patients with EST perforations. Pondering to
be minimally by invasive, advanced age still contributes to a higher complication and mortality risk in the
surgical treatment of ERCP.
Keywords : Risk factors, Surgical outcome, ERCP
