Indications, incidence and risk factors of early complications of endoscopic retrograde cholangiopancreatography as seen in Kenyatta national hospital.

Abstract

Background Endoscopic Retrograde Cholangiopancreatography (ERCP) is a common procedure in any general surgical service with both diagnostic and therapeutic indications. Complications associated with this procedure are either early or late and include pancreatitis, infections, bleeding and perforations. Despite this being a part of the surgical armamentarium at the Kenyatta National Hospital (KNH), there is paucity of data on the associated early complications. Objective To describe the indication, incidents and factors associated with early complications of ERCP in KNH. Study Design This was a prospective observational study. Study Setting Kenyatta National Hospital endoscopy unit, general surgical and medical wards. Methodology All patients who were undergoing ERCP in the endoscopy unit were recruited by consecutive sampling. Informed consent was obtained from the patients. The patients were followed up for the first 72 hours after ERCP had been performed in both medical and surgical wards and the various complications documented by both clinical examination and laboratory tests. Data Management and Analysis A structured data collection sheet was used to collect data. The data was entered in the SPSS version 21.0 for analysis and presented in pie charts, tables and graphs format. P value and 95% confidence interval was used to determine statistical significance. Incidence of complications was calculated and presented as frequencies and proportions. The association between age, gender, length and indication of procedure was compared using chi square. Results Ninety nine (99) patients were recruited of which ninety eight (98) completed the follow up. The most common clinical indication for ERCP was obstructive jaundice (96.9%) while the most common radiological indication for ERCP was choledocholithiasis (33%). The overall rate of complication was 22.7%, with acute pancreatitis and cholangitis being 12.4% each and bleeding 6%. No patient developed perforation as a complication. Women were found to have more complications as compared to men as well as older people as compared to younger patients. Out of the patients who had undergone prior ERCP only three (3) developed complications as compared to nineteen (19) who developed complications and had not undergone prior ERCP. Conclusion Obstructive jaundice still remains to be the most common clinical indication for ERCP while pancreatitis and cholangitis still remain to be the leading complications post ERCP. Female gender still is a risk factor for developing complications given that most patients are females. However younger age, longer procedure time and prior ERCP are not predisposing factors to developing complications.