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Revista Colombiana de Gastroenterologia

Print version ISSN 0120-9957

Abstract

GOMEZ ZULETA, Martín Alonso; DELGADO, Lindsay  and  ARBELAEZ, Víctor. Risk factors for endoscopic retrograde cholangiopancreatography (ERCP) associated with pancreatitis and hyperamylasemia. Rev Col Gastroenterol [online]. 2012, vol.27, n.1, pp.7-20. ISSN 0120-9957.

Although both asymptomatic hyperamylasemia and pancreatitis are clinical situations associated with endoscopic retrograde cholangiopancreatography (ERCP), asymptomatic hyperamylasemia is a very serious entity while asymptomatic pancreatitis has minimal significance. Risks for patients following ERCP have been described in various publications, but the behavior of these factors varies from one population to another. For this reason it has become important to study these factors in our own environment to identify which patients have higher probabilities of pancreatitis and/or hyperamylasemia following ERCP so that we can make clinically applicable recommendations. Materials and methods. This is a cross sectional, analytical, prospective and observational study of patients who underwent ERCP at the Hospital El Tunal. Before undergoing ERCP all patients filed out a form about their most important epidemiological variables, laboratory study results and imaging study results. After undergoing the procedure they remained in the hospital for at least 24 hours during which time amylase levels, pain, and other complications were monitored and evaluated. Results. 152 patients met the study's inclusion requirements. All underwent ERCP because of cholestasis and dilation of the extrahepatic bile duct. 94 of these patients (61.8%) were women. Patients average age was 60.07 ± 15.9 years. The incidence of hyperamylasemia was 65.8 % (n=100), but only nine of these cases were accompanied by the abdominal pain typical of hyperamylasemia after the first 24 hours following the procedure. In other words, the incidence of pancreatitis following ERCP was 5.9% (n=9) while the incidence of asymptomatic hyperamylasemia was 59.8% (91 patients). Four risk factors for pancreatitis were identified: multiple attempts at biliary cannulation (OR 23.6), precut papillotomy (OR 6.0), use of contrast media in biliary duct radiography (OR 4.65), and placement of a biliary stent (OR 5.19). Conclusion. Our work demonstrates that pancreatitis following ERCP is a very common complication, but that asymptomatic hyperamylasemia is even more common. Even though the latter does not have any implications for the patient, it does have implications for clinical practice. Our current recommendation for monitoring a patient following an ERCP is that no testing for amylases needs to be done if that patient has no abdominal pain since 60% of these cases will have elevated levels of amylase which could generate confusion. Of the four risk factors which were identified which might potentially be modified, the most important is that the ERCP should be performed by a well trained professional.

Keywords : Endoscopic retrograde cholangiopancreatography (ERCP); complications; pancreatitis; hyperamylasemia.

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