PTH-001\u2005SEMS is a risk Factor for post-ERCP pancreatitis: experience from a high-volume UK hospital

Abstract

Introduction Studies have attempted to examine the risk of post-ERCP pancreatitis (PEP) with the placement of biliary self-exapandable metal stent (SEMS) with conflicting results. The aim of this study is to investigate whether biliary SEMS is a potential risk factor for PEP. Methods All patients who underwent ERCP between January 2016 and May 2017 at Gastrointestinal Endoscopy Unit at Milton Keynes University Hospital (MKUH) were included in this retrospective study. Patients included in this study underwent first time ERCP as indicated, including patients who developed PEP. PEP was defined according to consensus criteria. Patients who developed complications other than PEP, those who had failed procedure due to anatomical deformity, previous ERCP, or active pancreatitis at the time of ERCP were excluded. Results A total of 260 patients who underwent ERCP between January 2016 and May 2017 were included in this retrospective study. After applying exclusion criteria 29 patients were excluded and 231 patients were included in the final analysis. PEP occurred in 8.6% (20/231) of all patients. Normal serum bilirubin was the only patient related risk factor which showed statistically significant association with PEP on univariate analysis (P=0.001). On univariate analysis of procedure risk factors we found that pancreatic guidewire cannulation, pancreatic contrast injection, and biliary metal stent insertion showed statistically significant association with PEP. Multivariate analysis after binary logistic regression analysis revealed that normal serum bilirubin (P<0.001) and bilary metal stent insertion (P=0.001) are independent risk factors for PEP. Pancreatic guidewire cannulation and pancreatic contrast injection increased the risk of PEP, but this was not statistically significant on the multivariate analysis. Conclusions Normal serum bilirubin and biliary metal stent placement were independent risk factors for the occurrence of PEP. Further research is needed to investigate the etiological factors contributing to the development of PEP after biliary SEMS insertion. This will help to develop strategies to reduce SEMS related pancreatitis.