Our experiences in 1000 case single-centre endoscopic retrograde cholangiopancreatography
Authors: Uğurlu Esat Taylan 
Published: November 2022

Background:
Endoscopic retrograde cholangiopancreatography (ERCP) has a very important role in both diagnosis and treatment of pancreaticobiliary pathologies. The aim of this study was to review the indications, technical success complications and results of ERCP procedures performed in our centre.

Materials and Methods:
In the study, the data of 1000 patients who were diagnosed with extrahepatic cholestasis, obstructive cholangitis/pancreatitis or bile leakage in clinical, medical and radiological data and who underwent ERCP between May 2019 and November 2021 were evaluated retrospectively.

Results:
The age distribution was between 14 and 109 years, and the average age was 57.97 years for women (14–109) and 57.48 for men (19–95). Gender distribution was as follows: 552 (55.2%) women and 448 (44.8%) men. ERCP indications in this study were as follows: choledocholithiasis, malignant bile duct obstruction, odysphincter dysfunction (ODS), post-operative bile leakage, hepatic hydatid cyst rupture into the biliary tract and bile duct stenosis. Eight hundred and seventy-one (87.1%) patients had common bile duct stones, 30 (3%) pancreatic head tumour, 22 (2.2%) common bile duct tumour and 20 (2%) cholestasis due to papilla tumour and/or obstructive icterus. Twenty-two (2.2%) patients were treated for sphincter dysfunction (ODS) of Oddi. ERCP was performed in 12 (1.2%) patients with the diagnosis of bile leakage after liver hydatid surgery, 10 (1%) after gall bladder surgery and 8 (0.8%) with the diagnosis of biliary tract stenosis after gall bladder surgery. ERCP was performed in 5 (0.5%) patients due to biliary tract obstruction as a result of rupture of hydatid liver cyst into the biliary tract. Successful cannulation was achieved in 1000 patients listed. Ninety-seven patients who were included in the ERCP procedure but could not be cannulated were not included in the study. Endoscopic sphincterotomy was performed on all patients in the ERCP procedure. In patients with choledochal stones, stone extraction from the common bile duct and/or plastic stent placement in the common bile duct was added. Plastic stent was placed in the common bile duct in patients with pancreatic head tumour, common bile duct tumour, bile duct leakage and common choledochal stenosis. Endoscopic biopsy was taken from all patients with suspected papillary tumour. The processing time varied between 15 and 90 min. The overall complication rate was 17.4%. After ERCP, 93 patients developed amylasaemia that did not require treatment, while 50 patients were diagnosed with clinical and laboratory acute pancreatitis. Intraoperative bleeding, which did not require blood transfusion and could be controlled with adrenaline injection and/or balloon pressure, developed in 10 patients. In one patient, basket and stone were stuck in the papilla during stone extraction. There was no operative mortality.

Conclusion:
ERCP is a complex procedure that uses special equipment and must be performed by experienced specialists. To increase the reliability of the ERCP procedure, it is necessary to determine the risk factors for ERCP complications very well. Unnecessary ERCP should be avoided. ERCP should not be performed, especially in patients with low probability of stone or stricture, patients with normal bilirubin and patients who do not show other signs of biliary disease. The use of non-invasive imaging methods as much as possible instead of diagnostic ERCP will reduce the complications associated with ERCP.