ERCP-related perforations: a population-based study of incidence, mortality, and risk factors
Background Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to...
Gespeichert in:
| Veröffentlicht in: | Surgical endoscopy 2020-05, Vol.34 (5), p.1939-1947 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1947 |
|---|---|
| container_issue | 5 |
| container_start_page | 1939 |
| container_title | Surgical endoscopy |
| container_volume | 34 |
| creator | Langerth, Ann Isaksson, Bengt Karlson, Britt-Marie Urdzik, Jozef Linder, Stefan |
| description | Background
Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.
Methods
Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed.
Results
Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%,
p
= 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%,
p
= 0.024).
Conclusions
ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered. |
| doi_str_mv | 10.1007/s00464-019-06966-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_476758</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2297537220</sourcerecordid><originalsourceid>FETCH-LOGICAL-c615t-9f00178decf33451258e357ce17719d271a4d8a9a5e3e1fb910b2afd2c3d09fc3</originalsourceid><addsrcrecordid>eNp9kk1vEzEQhi0EoiHwBziglbhwiMEf6_WaQ6UqlA-pEggBN2Q59ji43awXe5co_x6nCYUiwcGyx_O84_HoRegxJc8pIfJFJqRuakyowqRRTYO3d9CM1pxhxmh7F82I4gQzqeoT9CDnS1J4RcV9dMKpEEpIOUNfzz8uP-AEnRnBVQMkH5MZQ-zzy8pUQxym7jrEK5MLkMfJ7aroq9Db4KC3sKg2MY2mC-NuUZneVSnkq8obO8aUH6J73nQZHh33Ofr8-vzT8i2-eP_m3fLsAtuGihErTwiVrQPrOa8FZaIFLqQFKiVVjklqatcaZQRwoH6lKFkx4x2z3BHlLZ8jfKibtzBMKz2ksDFpp6MJ-nh1VU6ga9lI0RZ-8U_-VfhypmNa62nSNWlJTQp-esALuwFnoR-T6W6pbmf68E2v4w8tKeWsrDl6diyQ4vcJ8qg3IVvoOtNDnLJmTCnKRUP26NO_0Ms4pb5Mb09JwSVj-47YgbIp5pzA3zRDid6bQx_MoYs59LU59LaInvz5jRvJLzcUgB_HUlL9GtLvt_9T9ifThMdO</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2297537220</pqid></control><display><type>article</type><title>ERCP-related perforations: a population-based study of incidence, mortality, and risk factors</title><source>SWEPUB Freely available online</source><source>SpringerLink Journals - AutoHoldings</source><creator>Langerth, Ann ; Isaksson, Bengt ; Karlson, Britt-Marie ; Urdzik, Jozef ; Linder, Stefan</creator><creatorcontrib>Langerth, Ann ; Isaksson, Bengt ; Karlson, Britt-Marie ; Urdzik, Jozef ; Linder, Stefan</creatorcontrib><description>Background
Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.
Methods
Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed.
Results
Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%,
p
= 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%,
p
= 0.024).
Conclusions
ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.</description><identifier>ISSN: 0930-2794</identifier><identifier>ISSN: 1432-2218</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-019-06966-w</identifier><identifier>PMID: 31559577</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Bile ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Medicine ; Medicine & Public Health ; Mortality ; Pancreatic cancer ; Pancreatitis ; Population ; Population-based studies ; Proctology ; Risk factors ; Studies ; Surgery ; Systematic review</subject><ispartof>Surgical endoscopy, 2020-05, Vol.34 (5), p.1939-1947</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c615t-9f00178decf33451258e357ce17719d271a4d8a9a5e3e1fb910b2afd2c3d09fc3</citedby><cites>FETCH-LOGICAL-c615t-9f00178decf33451258e357ce17719d271a4d8a9a5e3e1fb910b2afd2c3d09fc3</cites><orcidid>0000-0001-5052-6922</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-019-06966-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-019-06966-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31559577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-408040$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143334465$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Langerth, Ann</creatorcontrib><creatorcontrib>Isaksson, Bengt</creatorcontrib><creatorcontrib>Karlson, Britt-Marie</creatorcontrib><creatorcontrib>Urdzik, Jozef</creatorcontrib><creatorcontrib>Linder, Stefan</creatorcontrib><title>ERCP-related perforations: a population-based study of incidence, mortality, and risk factors</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.
Methods
Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed.
Results
Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%,
p
= 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%,
p
= 0.024).
Conclusions
ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.</description><subject>Abdominal Surgery</subject><subject>Bile</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Pancreatic cancer</subject><subject>Pancreatitis</subject><subject>Population</subject><subject>Population-based studies</subject><subject>Proctology</subject><subject>Risk factors</subject><subject>Studies</subject><subject>Surgery</subject><subject>Systematic review</subject><issn>0930-2794</issn><issn>1432-2218</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><sourceid>D8T</sourceid><recordid>eNp9kk1vEzEQhi0EoiHwBziglbhwiMEf6_WaQ6UqlA-pEggBN2Q59ji43awXe5co_x6nCYUiwcGyx_O84_HoRegxJc8pIfJFJqRuakyowqRRTYO3d9CM1pxhxmh7F82I4gQzqeoT9CDnS1J4RcV9dMKpEEpIOUNfzz8uP-AEnRnBVQMkH5MZQ-zzy8pUQxym7jrEK5MLkMfJ7aroq9Db4KC3sKg2MY2mC-NuUZneVSnkq8obO8aUH6J73nQZHh33Ofr8-vzT8i2-eP_m3fLsAtuGihErTwiVrQPrOa8FZaIFLqQFKiVVjklqatcaZQRwoH6lKFkx4x2z3BHlLZ8jfKibtzBMKz2ksDFpp6MJ-nh1VU6ga9lI0RZ-8U_-VfhypmNa62nSNWlJTQp-esALuwFnoR-T6W6pbmf68E2v4w8tKeWsrDl6diyQ4vcJ8qg3IVvoOtNDnLJmTCnKRUP26NO_0Ms4pb5Mb09JwSVj-47YgbIp5pzA3zRDid6bQx_MoYs59LU59LaInvz5jRvJLzcUgB_HUlL9GtLvt_9T9ifThMdO</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Langerth, Ann</creator><creator>Isaksson, Bengt</creator><creator>Karlson, Britt-Marie</creator><creator>Urdzik, Jozef</creator><creator>Linder, Stefan</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>ACNBI</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DF2</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-5052-6922</orcidid></search><sort><creationdate>20200501</creationdate><title>ERCP-related perforations: a population-based study of incidence, mortality, and risk factors</title><author>Langerth, Ann ; Isaksson, Bengt ; Karlson, Britt-Marie ; Urdzik, Jozef ; Linder, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c615t-9f00178decf33451258e357ce17719d271a4d8a9a5e3e1fb910b2afd2c3d09fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Bile</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Pancreatic cancer</topic><topic>Pancreatitis</topic><topic>Population</topic><topic>Population-based studies</topic><topic>Proctology</topic><topic>Risk factors</topic><topic>Studies</topic><topic>Surgery</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Langerth, Ann</creatorcontrib><creatorcontrib>Isaksson, Bengt</creatorcontrib><creatorcontrib>Karlson, Britt-Marie</creatorcontrib><creatorcontrib>Urdzik, Jozef</creatorcontrib><creatorcontrib>Linder, Stefan</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Uppsala universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Uppsala universitet</collection><collection>SwePub Articles full text</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Langerth, Ann</au><au>Isaksson, Bengt</au><au>Karlson, Britt-Marie</au><au>Urdzik, Jozef</au><au>Linder, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ERCP-related perforations: a population-based study of incidence, mortality, and risk factors</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>34</volume><issue>5</issue><spage>1939</spage><epage>1947</epage><pages>1939-1947</pages><issn>0930-2794</issn><issn>1432-2218</issn><eissn>1432-2218</eissn><abstract>Background
Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.
Methods
Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed.
Results
Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%,
p
= 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%,
p
= 0.024).
Conclusions
ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31559577</pmid><doi>10.1007/s00464-019-06966-w</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5052-6922</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2020-05, Vol.34 (5), p.1939-1947 |
| issn | 0930-2794 1432-2218 1432-2218 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_476758 |
| source | SWEPUB Freely available online; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Bile Endoscopy Gastroenterology Gynecology Hepatology Hospitals Medicine Medicine & Public Health Mortality Pancreatic cancer Pancreatitis Population Population-based studies Proctology Risk factors Studies Surgery Systematic review |
| title | ERCP-related perforations: a population-based study of incidence, mortality, and risk factors |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T11%3A49%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ERCP-related%20perforations:%20a%20population-based%20study%20of%20incidence,%20mortality,%20and%20risk%20factors&rft.jtitle=Surgical%20endoscopy&rft.au=Langerth,%20Ann&rft.date=2020-05-01&rft.volume=34&rft.issue=5&rft.spage=1939&rft.epage=1947&rft.pages=1939-1947&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-019-06966-w&rft_dat=%3Cproquest_swepu%3E2297537220%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2297537220&rft_id=info:pmid/31559577&rfr_iscdi=true |