Risk factors of post-ERCP complications: a single-center retrospective study

Objective. To analyze standalone and synergistic risk factors of early post-ERCP adverse events. Material and methods. We retrospectively reviewed case records of patients with choledocholithiasis who underwent endoscopic lithoextraction (n=876) between 2018 and 2023. Significant risk factors, odds ratios (OR) and threshold values were identified for postoperative complications. Combinations of factors and their cumulative effect were obtained using regression analysis. Results. There were the following postoperative complications: hyperamylasemia (5.8%), acute pancreatitis (5.5%), cholangitis (2.4%), acute obstructive cholecystitis (2.2%), perforations (1.6%), delayed bleeding (0.6%). Double-wire cannulation (OR 3.3 and 9, respectively), endoscopic papillosphincterotomy (OR 7.32 and 7.85, respectively) and pancreatic stenting (OR 3.75 and 3.95, respectively) contributed to pancreatitis and hyperamylasemia. New factors were additionally identified for hyperamylasemia (use of Dormia basket and balloon in one session (OR 2) and intraoperative bleeding (OR 3.2)). Predictors of cholangitis (lithotripsy (OR 2.8), sludge in ducts (OR 3.4), cholecystectomy (OR 3), age < 51.5 years) and cholecystitis (choledocholithiasis < 6.5 mm (OR 3.4)) were identified for the first time. We first revealed significant relationship between intraoperative bleeding and lithotripsy with perforation and cumulative effect of combination of factors on hyperamylasemia and cholangitis. There was no effect of elevated preoperative liver enzymes on complications. Conclusion. The previously mentioned and new risk factors of post-ERCP complications were identified. There were single and combined factors causing a synergistic effect. These predictors of complications should be taken into account at all stages of treatment to minimize the incidence and severity of complications.