Predictors of postendoscopic retrograde cholangiopancreatography associated cholangitis: a retrospective cohort study

Background/aim: Post-ERCP cholangitis (endoscopic retrograde cholangiopancreatography) and associated sepsis can be lifethreatening. Despite the wealth of studies on post-ERCP pancreatitis risk factors, there is limited data on post-ERCP cholangitis. This study aimed to investigate the rates, predictors, and outcomes of post-ERCP cholangitis. Materials and methods: A retrospective review of 452 ERCP cases performed by a single endoscopist at a tertiary center between March 2019 and February 2021 was performed. Patient-related, organizational and periprocedural factors that could affect post-ERCP cholangitis were evaluated. Predictors of post-ERCP cholangitis were determined by multivariable analysis. Results: The post-ERCP cholangitis rate was 19.5%. Cholangiocarcinoma (OR 15.72, CI 2.43–101.55, p = 0.004), the American Society of Anesthesiologist Score (ASA) (OR 2.87, CI 1.14–7.21, p = 0.024), an increase in bilirubin after ERCP (OR 1.81 CI 1.01–3.22, p = 0.043), body mass index (OR 1.15, CI 1.00–1.33, p = 0.04) and procedure duration (OR 1.02, CI 1.00–1.05, p = 0.049) were predictors of post-ERCP cholangitis. Biliary stone extraction using a balloon was found to be protective against cholangitis (OR 0.18, CI 0.05–0.60, p = 0.005). Sepsis rate related to post-ERCP cholangitis was 2.4% and death 1%. Conclusion: Patients who undergo ERCP procedures due to malignant bile duct stenosis, have a high ASA score and BMI, and have a long procedure time should be paid attention and closely monitored. Further research is needed to determine whether measures aimed at the identified risk factors will reduce the incidence of post-ERCP.

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