Indications, outcomes and complications of therapeutic endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre in North East India

Bikash Narayan Choudhury, Utpal Jyoti Deka, Bhaskar Jyoti Baruah, Mallika Bhattachayya, Preeti Sarma, Porag Debroy


Background: Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is one of the most complex endoscopic procedures in the management of several pancreatobiliary diseases. There is no comprehensive data available till date about ERCP procedures from North East India. The aim of this study was to review the indications, outcomes and complications of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a tertiary care centre of North East India.

Methods: We retrospectively analysed the clinical records of all patients undergoing ERCP between July 2011 and November 2019. ERCP was performed under sedation (Midazolam + Pentazocine). Patient’s demographic characters, ERCP indications, outcome and post-ERCP complications were reviewed. Potential important patient and procedure related risk factors for overall post-ERCP complications were investigated.

Results: A total 1038 patients were included in the study. Cannulation of the desired duct was successful in 89.2% of ERCPs. Among them male patients were 392 and females were 646. Mean age was 45 years and the age range were 7 to 92 years. Commonest indication was choledocholithiasis followed by malignancy. Overall Success rate was 82.66% with 84.64% in CBD stone and 75.65% in stenting of malignancy. Post ERCP complications developed in 96 patients (9.2%) and pancreatitis was the most common post-ERCP complication. Sedation related complications occurred only in few cases.

Conclusions: Despite its associated morbidity and risk of mortality, ERCP is an important method for managing the pancreatic-biliary diseases. Indications, outcomes, and complications of therapeutic ERCPs in our centre are comparable to those reported from other centres.


Cholangitis, Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Haemorrhage, Pancreatitis, Perforation, Sphincterotomy

Full Text:



Baron TH, Petersen BT, Mergener K. Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 2006;101:892-97.

Freeman ML. Current status of endoscopic stenting of the pancreatic duct as prophylaxis against post-ERCP pancreatitis. Gastroenterol Hepatol. 2012;8:618-20.

Jeurnink SM, Siersema PD, Steyerberg EW, Dees J, Poley JW, Haringsma J, et al. Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge. Surg Endo. 2011;25:2892-900.

Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastro Endo. 2009;70:80-8.

Freeman ML, Nelson DB, Sherman S. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909-18.

Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography related adverseevents: general overview. Gastrointest Endosc Clin N Am. 2015;25:97-106.

Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383-93.

Ferreira LE, Baron TH. Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol. 2007;102:2850-8.

Freeman ML. Adverse outcomes of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2003;13:775-98.

Mallery JS, Baron TH, Dominitz JA. Complications of ERCP. Gastrointest Endosc. 2003;57:633-8.

Andriulli A, Loperfido S, Napolitano G. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102:1781-8.

Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo guidelines, 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54.

Vitte RL, Morfoisse JJ. Investigator Group of Association Nationale des Gastroenterologues des Hopitaux Generaux. Evaluation of endoscopic retrograde cholangiopancreatography procedures performed in general hospitals in France. Gastroenterol Clin Biol. 2007;31:740-9.

Kapral C, Duller C, Wewalka F. Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endo. 2008;40:625-30.

Coté GA, Imler TD, Xu H, Teal E, French DD, Imperiale TF, et al. Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography. Med Care. 2013;51:1040-7.

Williams EJ, Taylor S, Fairclough P. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007;39(9):793-801.

Kapral C, Duller C, Wewalka F, et al. Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endo. 2008;40:625-30.

Salminen P, Laine S, Gullichsen R. Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center. Surg Endosc. 2008:22;1965-70.

Kochar B, Akshintala VS, Afghani E, Elmunzer BJ, Kim KJ, Lennon AM, et al. Incidence, severity, and mortality of post- ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc. 2015;81:143-9.

Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endo. 2003;35:830-4.

Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96(2):417-23.