Tani ve tedavi amaçli ERCP’nin pankreatit basta olmak üzere kolanjit, kanama, perforasyon ve kardiyorespiratuvar komplikasyonlari vardir. Bu çalismanin amaci tedavi amaçli ERCP komplikasyonlari ve bunlar üzerine etkili risk faktörlerini belirlemektir. Bu amaçla tek merkezde ayni endoskopist tarafindan gerçeklestirilen ardisik 100 ERCP isleminde, isleme bagli erken komplikasyonlarin sayi ve siddeti ile islem öncesi, sirasi ve sonrasinda kaydedilen çok sayida klinik ve laboratuvar parametrenin degerlendirildigi prospektif bir çalisma planlandi. Yüz hastadan ikisinde daha önce geçirilmis mide operasyonu ve Bilroth-II tipi gastrojejunostomi ve 2 hastada duodenum tümörü nedeniyle papile ulasilamadigindan ERCP yapilamadi. Geriye kalan 96 hastadan 86 sinda selektif koledok kanulasyonu, 9 hastada ön kesiyi takiben koledok kanulasyonu ve 1 hastada perkütan-endoskopik kombine girisim ile koledok kanulasyonunu takiben terapotik ERCP gerçeklestirildi. Bir hastada pankreatit, kolanjit ve kanama, 1 hastada kolanjit, 1 hastada pankreatit ve 2 hastada kanama olmak üzere toplam 5 (%5.2) hastada 7 (%7.29) komplikasyon görüldü. Komplikasyonlar hafif ve orta siddette olup mortalite yoktu. Komplikasyon gelisen hastalarin hepsi kadindi ve ikisinde kalinti koledok tasi vardi. Kadin cinsiyet ve kalinti koledok tasi terapotik ERCP komplikasyonlari üzerine etkili risk faktörleri olarak saptandi. Koledok tasinda EST yi takiben koledok temizligi yapildiktan sonra opak madde verilerek kontrol kolanjiografi çekildiginde opak örtmesine bagli küçük taslar gözden kaçabilir ve ilk 24 satte oddideki ödeme bagli spontan düsüs olamayacagindan bizim 1 hastamizda oldugu gibi pankreatit, kolanjit ve kanamaya neden olabilir. Bu nedenle islem bittikten sonra hastalari sirtüstü çevirip kalinti koledok tasi açisindan skopi ile kontrol yapilmali ve tas varsa spontan düsüs beklenmeden tekrar duodenoskopla girilerek islem tamamlanmalidir. Sonuç olarak endoskopistin deneyimi dahil çok sayida teknik ve hastayla ilgili faktör ERCP ile ilgili komplikasyon oranini artirmaktadir. Endoskopistin yeterli deneyim kazanmasi, yüksek riskli hastalarin belirlenerek mümkünse ERCP’den vazgeçilmesi veya islemden kaynaklanan risk faktörlerinin azaltilmasi ve tanisal ERCP yerine mümkün oldugu kadar invaziv olmayan görüntüleme yöntemlerinin kullanilmasi ERCP ile iliskili komplikasyonlari azaltacaktir.
Other than pancreatitis, diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) can result in several complications - primarily cholangitis, bleeding, perforation and cardio-respiratory side effects. In this study, we investigated complications of therapeutic ERCP and the risk factors associated with these complications. We did a retrospective study on 100 patients who had undergone ERCP procedure by the same endoscopist and evaluated data regarding clinical and laboratory parameters obtained pre-, during and soon after the ERCP procedure. ERCP could not be done in two patients because of previous gastric operation and Billroth II type gastrojejunostomy and in another two patients who had obstructing duodenum tumor which prevented reaching the papilla. We did selective choledochal cannulation in 86 of 96 patients; nine cases had undergone precut sphincterotomy before selective cannulation, and in one case, percutaneous and endoscopic combined method had been used to cannulate the common bile duct. Totally, seven (7.29%) complications in five patients (5.2%) were observed as follows: one patient had pancreatitis, cholangitis and bleeding; one had cholangitis; one had pancreatitis and bleeding and two had bleeding. There was no mortality, though mild and moderate procedure-related morbidities were noted. All the patients who developed complications were female and two had had residual common bile duct stone. The female gender and residual bile duct stone were determined to be the main risk factors in therapeutic ERCP. After sphincterotomy and cleaning of the common bile duct, the cholangiographic images can miss small stones due to contrast material, and during the first 24 hours, the Oddi edema can prevent spontaneous passage of the residual stone. Thus, as was seen in one of our patients, pancreatitis, cholangitis and bleeding can develop in these cases. Thus, patients should be checked with scopes and in the case of a residual stone, extraction should be completed without delay rather than waiting for spontaneous release. In conclusion, specific patient- and procedure- related factors, including operator experience, can increase the risk of ERCP-related complications. Precise identification of risk factors for complications of ERCP is essential to recognize high-risk cases in which ERCP should be avoided if possible. Furthermore, use of noninvasive imaging modalities instead of diagnostic ERCP and performance of ERCP by an experienced endoscopist will decrease ERCP-related complications.