Endoscopic retrograde cholangiopancreatography consultation after digestive tract reconstruction and risk factors for complications.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the diagnosis and treatment of biliary and pancreatic diseases, and its success rate and therapeutic effect are considerable, and its use in patients with gastrointestinal tract reconstruction is also increasing. The anatomical structure of the digestive tract has been changed in these patients, which makes the use of endoscopic retrograde cholangiopancreatography technically more challenging. The aim of this study was to investigate the efficacy of transendoscopic retrograde cholangiopancreatography in patients after gastrointestinal reconstruction and its risk factors for postoperative complications.

Methods: A retrospective analysis was conducted on clinical data of 522 patients who underwent ERCP for diagnostic and therapeutic purposes after gastrointestinal reconstruction surgery at Zhongnan Hospital, Wuhan University, from January 2017 to December 2023. Univariate analysis, multicollinearity testing, and binary logistic regression were performed to explore the factors associated with ERCP efficacy and complications.

Results: A total of 522 patients were included in the study. The success rate of intubation was 96.93% (506/522), the success rate of cannulation was 91.09% (466/506), and the therapeutic success rate was 95.28% (444/466). Multivariate logistic regression analysis of failed intubation showed that independent risk factors included total gastrectomy (P = 0.000, OR = 7.114, 95% CI 2.454-20.622), gastrojejunostomy (P = 0.000, OR = 46.881, 95% CI 10.250-214.423), and the use of a forward-viewing endoscope (P = 0.010, OR = 2.322, 95% CI 1.228-4.389). Post-ERCP complications included hyperamylasemia in 67 cases (12.84%), acute pancreatitis in 13 cases (2.49%), acute cholangitis in 3 cases (0.57%), bleeding in 3 cases (0.57%), and perforation in 2 cases (0.38%). Univariate analysis of the complications showed that a history of cholecystectomy (P = 0.042, OR = 1.800, 95% CI 1.015-3.193) was an independent risk factor for hyperamylasemia; difficult cannulation (P = 0.000, OR = 47.619, 95% CI 13.317-170.275) was an independent risk factor for acute pancreatitis; and a history of pancreatitis (P = 0.040, OR = 42.75, 95% CI 3.399-537.620) was an independent risk factor for bleeding.

Conclusions: ERCP performed in patients after gastrointestinal reconstruction at our hospital achieved a high success rate. Total gastrectomy, gastrojejunostomy, and the use of a forward-viewing endoscope were independent risk factors for failed intubation. A history of cholecystectomy, recurrent cannulation, and a history of pancreatitis were identified as independent risk factors for hyperamylasemia, acute pancreatitis, and bleeding, respectively.