Outcomes of pancreatic therapeutic ERCP as compared with biliary therapeutic and diagnostic ERCP: A prospective multisite study

Endoscopic therapeutics on the pancreatic sphincter(s) and duct(s) (Pancr-Tx) are increasingly performed at tertiary centers, yet little is known of their utilization or outcomes in other settings. Methods: All consecutive ERCP's attempted at 11 centers (6 private, 5 university) were prospectively studied. Procedure data were recorded at time of ERCP and outcomes were assessed at 30 days. Complications were denned by established consensus criteria, and included indirect events. Intent-to-treat was considered a success only if sphincterotomy (ES), stone clearance, stricture drainage or other Tx of the intended duct(s) was total at first procedure. Results: Of 1,586 ERCP, intent was biliary Tx only in 1,019 (64%), Dx only in 341 (22%), and Pancr-Tx in 226 (14%). Intended Pancr-Tx comprised 22% of all ERCP at academic centers vs 5% in private practices. Intended Pancr-Tx included pancreatic stent insertion (n=167) and/or removal (n = 68), pancreatic ES of major (n=60) or minor papilla (n = 22), stricture dilation (n = 53), pancreatic stone extraction (n = 17), tissue sampling (n = 14), and other Tx (n = 14). Dx only n = 341 Biliary Tx n=1,019 Pancr-Tx n=226 % including ES 0% 65% bil ES 35% pancrES Success rate 90% 88% 85% Complications 6.5% 10.8% 24.8%*(Pancreatitis) (5.9%) (4.2%) (18.2%)*(Severe cpmpl'ns) (0.9%) (1.2%) (1.3%) ERCP-related hospital daysmean = 1.0 ± 0.1*mean = 1.6 ± 0.1 mean = 2.0 ± 0.3*P<0.05 versus others For ES, complication rates were 80/842 (9.5%) for Dx or Tx ERCP without ES, 79/666 (11.9%) with biliary ES, and 29/78 (37.2% )*with pancreatic ES (49 pancr ES and 29 combined pancr/bil ES). Conclusions: Pancreatic therapeutic ERCP is less successful, and has a significantly higher overall complication rate than purely diagnostic or biliary therapeutic ERCP, despite its performance primarily in specialized centers. Its effectiveness needs further study.