Risk factors for success, complications and death after endoscopic sphincterotomy for bile duct stones: a 17- year experience with 2137 cases

Júlio Carlos Pereira Lima, Ivan David Arciniegas Sanmartin, Bruna Latrônico Palma, Carlos Eduardo Oliveira dos Santos
2020 Digestive Diseases  
Risk factors for post-ERCP complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones, are poorly-determined. This study aims to verify risk factors for mortality, complications and success after EST. A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. 5226 ERCPs were performed, of which 2137 were in patients with bile duct stones (1458 women and 679 men; mean age = 57 years) who
more » ... nderwent EST with attempted stone removal. There were 171 (8%) complications being pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2028 cases (94.9%). On multivariate analysis, mortality was associated with age > 60 yr. (1 vs. 0.2%), cholangitis (4.3 vs.0.3%) and EST--related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%) and complications (86.5 vs. 95.6%). Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication or those who presented initially with cholangitis. Difficult cannulation, EST-related complications and pre-cut were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval showed to be as safe as performing the procedure in hospitalized patients.
doi:10.1159/000507321 pmid:32187605 fatcat:zyecdhmxkbe35cbz7e7vdnoccu