A Single-Center, Prospective Study Focused on Quality Indicators, Success Rate, Features, Outcomes, and Indications of Endoscopic Retrograde Cholangiopancreatography (ECRP) Practice at a Tertiary Care Hospital
Authors: Panambur Anand Bhandary , R Rai Paraashar , Ignatius P Anand 
Published: January 2025

Objective: To assess, in a single center-based study, the indications, results, success rates, incidence, and risk factors for complications linked to endoscopic retrograde cholangiopancreatography (ERCP) procedure and validate the ASGE/American
College of Gastroenterology Task Force recommendations.
Methods: We conducted a prospective analysis of all patients who underwent ERCP at tertiary care center in Mangalore, India
between October 2018 and September 2023, a span of five years. ERCP was performed under sedation/ general anesthesia.
Review of the patient's demographics, ERCP indications, outcomes, quality indicators, and related complications of the procedure was analyzed. Potentially relevant patient and procedure related risk factors for overall post ERCP complications were
analyzed. To determine the likelihood of post-ERCP problems and post-ERCP pancreatitis (PEP) in patients with specific risk
factors, such as demographic characteristics, variations in procedural procedures, pancreatic duct modifications, and others,
two multivariate logistic regression models were performed.
Results: A total of 948 patients were included in this study. 76.2% of naïve papilla cannulation was achieved successfully;
68% of procedures include women, 32% involve men, 84% involve benign pathology, and 26% involve suspected or confirmed
malignancy. (42% women and 58% men). Suspected or confirmed choledocholithiasis was the commonest indication for an
ERCP. Success rates, operative outcomes, and post-procedural complications such as hemorrhage, pancreatitis, Cholangitis,
perforation were the primary outcomes of interest in our study. We also discussed the management of the failed procedures.
This was followed by suspected ascending cholangitis, acute biliary pancreatitis, dysfunction of the sphincter of Oddi, and
suspected malignancy. The most prevalent findings among all patients was choledocholithiasis in 43.6%, dilated duct in 35.8%
and biliary stricture in 10.1%. The most common intervention was sphincterotomy, which was performed in 851 (96.8%) patients who underwent first-ever ERCP, followed by dilatation and stenting. 10.9% of the patients had post-ERCP complications,
with post-ERCP pancreatitis being the commonest, followed by bleeding and cholangitis. Conclusions: In our center's ERCP procedures are carried out by experienced surgeons wellversed with endoscopic procedures who achieve good procedural outcomes, meeting the quality standards and good procedural success. Even ERCP has
some morbidity and mortality risk, it is a valuable tool for addressing pancreatobiliary disease. The technical success rates
met or beyond the ASGE/American College of Gastroenterology Task Force recommendations which was the main objective of
this study. When compared to other centers across the country and the western world, cannulation success rates are adequate
and comparable to the set norms. Since ERCP seldom results in mortality and has low rates of peri-operative complications, it
is regarded as a safe interventional biliary procedure.