Backgrounds and aim: endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure to drain the biliary and pancreatic ducts. Nevertheless, there are complications which seem to be more common in centers performing less than 200 ERCPs per year. Sometimes, however, due to the distribution of health resources, it is necessary to perform this technique in centers with a smaller number of procedures. We present the experience of ERCP-related complications in a small unit. Material and methods: this is a retrospective study on prospective data recorded during six years (1997-2002). In this period, two endoscopists working together performed 507 ERCPs, which yields an approximately average of 84 procedures per year. Results: in 507 ERCPs performed during this period of time, 55 complications arose (10.85%), and four patients died (0.79%) as a consequence of the procedure. There were 28 pancreatitis (5.5%), eight post-sphincterotomy bleeding events (1.6%), seven bilioduodenal perforations (1.4%), eight sepsis episodes of biliary origin (1.6%), and other 4 different complications. There were 418 (82.4%) successful ERCPs -either diagnostic or therapeutic-, which gave rise to 46 (11%) complications. There were 89 (17.6%) failed diagnostic or therapeutic ERCPs, which gave rise to 9 (10.11%) complications (p = 0.8 between both groups). Thirty five (7%) ERCPs were exclusively diagnostic and caused 6 (17%) complications. The 187 procedures performed for coledocho-lithiasis originated 14 (7.4%) complications, and represented the group with the lowest morbidity rate (p = 0.04). Conclusions: the complications rate in our center is within the range of reported figures. ERCPs performed for choledoco-lithiasis was associated with the lowest complications rate. The risk-benefit ratio in the anticipated, purely diagnostic ERCP must be carefully weighed due to its morbidity.
Antecedentes y objetivo: la colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento consolidado para el drenaje de la vía biliar y pancreática, que, sin embargo, conlleva complicaciones. El número parece ser mayor en los centros que realizan menos de 200 CPRE anuales. No obstante, en ocasiones, la distribución de los recursos sanitarios hace preciso realizar esta técnica en centros con menor número de procedimientos. Presentamos la experiencia de las complicaciones de la CPRE en una unidad pequeña. Material y métodos: estudio retrospectivo sobre unos datos recogidos de forma prospectiva durante seis años (1997-2002). En este periodo, dos endoscopistas, trabajando conjuntamente, han realizado 507 CPRE, lo que corresponde a una media aproximada de 84 procedimientos anuales. Resultados: en las 507 CPRE se produjeron 55 complicaciones (10,85%) y como consecuencia de ellas, cuatro pacientes fallecieron (0,79%). Hubo 28 pancreatitis (5,5%), 8 hemorragias postesfinterotomía (1,6%), 7 perforaciones bilioduodenales (1,4%), 8 sepsis de origen biliar (1,6%) y otras 4 complicaciones varias. Las CPRE con éxito diagnóstico y terapéutico -cuando se precisó- fueron 418 (82,4%), y presentaron 46 (11%) complicaciones. Hubo 89 (17,6%) CPRE con fallo diagnóstico o terapéutico, que presentaron 9 (10,11%) complicaciones (p=0,8 entre ambos grupos). Treinta y cinco (7%) CPRE fueron exclusivamente diagnósticas, presentando 6 (17%) complicaciones. Las 187 CPRE realizadas para extraer coledocolitiasis, con 14 (7,4%) complicaciones, fueron el grupo con menor morbilidad (p=0,04). Conclusiones: la tasa de complicaciones en nuestro centro se encuentra dentro de los rangos publicados. La extracción de coledocolitiasis fue el grupo de CPRE con menos complicaciones. Por su morbilidad, debe valorarse cuidadosamente el riesgo-beneficio de las exploraciones que se prevean exclusivamente diagnósticas.