Inadvertent injection of the duct not of primary interest during ERCP: Frequency and implications

M. Khorsandi, D. J. Drewitz, F. C. Ramirez

Research output: Contribution to journalArticlepeer-review

Abstract

During ERCP, injection of the duct not of primary interest occurs but its frequency and related implications are unknown. Aim: To determine the frequency of inadvertent injection in consecutive ERCPs, its associated new/complementary diagnoses and complication rates Study Design: Review of 613 consecutive ERCPs. Statistical Analysis: Chi-square. Setting: Endoscopy Unit VA Medical Center. Material and Methods: Consecutive ERCP reports at a VA Medical Center were reviewed. All ERCPs were performed by GI Fellows in training under the direct supervision of a therapeutic endoscopist. All ERCPs had a defined duct(s) of interest prior to the beginning of the procedure. Those ERCPs in which the duct not of primary interest was injected were evaluated for diagnosis, and complications. This group was compared with the group in which only the duct(s) of interest was injected. Results: Of 613 ERCPs evaluated, 33% (203) had the duct not of primary interest injected during the procedure: pancreatic duct 88% (179/203) and common bile duct 12% (24/203). In 35 ERCPs (17%) injection of the undesired duct lead to a complementary or new diagnosis. The complication rate as a result of the undesired injection was 5.9% (12/203) and not different from the group that had the duct(s) of primary interest opacified (4.2%) (p>0.05). Chronic pancreatitis: 15 CBD stricture due to C. pancreatitis/cancer: 6/1 Complementary/ Choledocholithiasis: 2 New Diagnoses Pancreas divisum: 1 Probable pancreatic cancer: 2 Unknown: 6 Dilated PD in acute GS pancreatitis: 3 Pancreatitis: 6 Complications Retroduodenal perforation: 3 Bleeding: 1 Febrile process: 2 Conclusions: 1) Inadvertent injection of the duct not of primary interest occurred in 33% of cases. 2) Inadvertent injection occurred most commonly in the pancreatic duct. 3) Injection disclosed pathology in 17% of cases. 4) Inadvertent injection of the duct not of primary interest did not increase the risk of complications.

Original languageEnglish (US)
Pages (from-to)AB136
JournalGastrointestinal endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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