Complications after endoscopic papillosphincterotomy

Abstract

Introduction: Endoscopic papillosphincterotomy (EPS) is now widely used to remove bile duct stones and to treat other problems, with mortality less than 2%. Most complications following the procedure are apparent within 24 hours and some will require emergency surgery. An awareness of the potential complications is important so that prompt and effective treatment can be instigated. Highlighting of the frequency of complications after EPS, the risk factors for complications of this procedure, their diagnosis and management, on behalf of literature and retrospective analysis of patients have undergone the procedure. Materials and methods: The study is based on the analysis of complications after EPS in patients whom undergone the procedure, performed in the surgical clinic of the National Scientific Practical Center of Emergency Medicine in Chisinau, in the time period of 2006-2013. Complications after procedure occurred in 40 cases. The study group was formed by 28 (70%) women and 12 (30% ) men. Average age was 53.5±17.18 (95% Cl: 48.01 - 58.99) years. In all cases EPS was performed with an Olympus duodenoscope JF1T-10, JF-10 or Pentax and the Demling and needle-knife sphincterotomes. We used descriptive statistics. Results: Of the 807 patients who underwent the EPS, complications occurred in 40 (4.95%) cases and were comm oner when EPS was performed for papillary stenosis (16.2%) than for CBD calculi (10.3%). Procedure-induced pancreatitis accounted more than half of complications (29 patients) and included all patients with severe abdominal pain and a serum amylase >1000 IU/1. Evidence of bleeding were found in 9 patients (1.2% of all EPS) and included all patients with haematemesis or melena following EPS. Retroperitoneal perforation was clinically evident in two patients. We did not encounter any case of death. Conclusion: The introducing of EPS has added a new dimension to the treatment of biliary tract disease. The number of patients undergoing EPS is increasing as the technique is applied more widely. The type and frequency of complications of endoscopic papillosphincterotomyvaried widely in different circumstances. Complications appear to be related primarily to the clinical indication for the procedure, to the characteristics of patients and to the endoscopic techniques, rather than to the age or gender of the patient. A correct preoperative management, access to advanced instruments and following the principles of endoscopic technique decreases the rate of complications.