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Post‐endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones
Author(s) -
Saito Hirokazu,
Koga Takehiko,
Sakaguchi Masafumi,
Kadono Yoshihiro,
Kamikawa Kentaro,
Urata Atsushi,
Imamura Haruo,
Tada Shuji,
Kakuma Tatsuyuki,
Matsushita Ikuo
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14604
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , pancreatitis , asymptomatic , general surgery , common bile duct stone , common bile duct , gastroenterology , radiology
Background and Aim For asymptomatic common bile duct (CBD) stones, removal by endoscopic retrograde cholangiopancreatography (ERCP) is recommended in available guidelines. However, few studies have reported the risk of post‐ERCP pancreatitis (PEP), which is the most common and serious ERCP‐related complication for asymptomatic CBD stones. We performed a propensity score matching analysis to examine the risk of PEP in therapeutic ERCP for asymptomatic CBD stones. Methods Information from medical databases of three institutions in Japan was collected over 6 years to identify 1113 patients with native papilla who underwent therapeutic ERCP for choledocholithiasis (excluding biliary pancreatitis). We compared the risk of PEP between asymptomatic and symptomatic groups by performing one‐to‐one propensity score matching. Results PEP was present in 52 (4.7%) of the 1113 patients overall. Of the 949 symptomatic patients, 28 (3.0%) had PEP, and of the 164 asymptomatic patients, 24 (14.6%) had PEP. The incidence of PEP was significantly higher in the asymptomatic group than in the symptomatic group (3.0% vs 14.6%; P < 0.001, odds ratio = 5.6). Of the 158 propensity score‐matched symptomatic patients, five (3.2%) had PEP. In contrast, of the 158 propensity score‐matched asymptomatic patients, 24 (15.2%) had PEP. Propensity score matching analysis revealed that the risk of PEP increased significantly in the asymptomatic group compared with the symptomatic group (3.2% vs 15.2%; P < 0.001, odds ratio = 5.5). Conclusions ERCP for asymptomatic CBD stones had a high risk of PEP. Endoscopists should explain in detail the risk of PEP to patients, especially those with asymptomatic CBD stones.