Factors associated with the severity of ERCP-related complications: a large retrospective single-centre study

Background Prospective studies have identified a number of patient- and procedure-related risk factors of post-ERCP complications. Many of these complications are mild and self-limiting. Aims The aim of this study is to identify the patients at risk of severe, early post-ERCP complications. Methods A retrospective cohort study was conducted using data from 2810 ERCP procedures performed at Ghent University Hospital from 2016 to 2022. Data were extracted from electronic patient records and a prospectively maintained ERCP registry. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for severe complications. Results Among the 2810 ERCP procedures, 223 cases (7,9%) with post-ERCP complications were analyzed. Severe complications were observed in 20.3% of these cases. Haemorrhage was the most reported severe complication (22/49 severe complications, 44.9%), while a perforation had the most chance to result in a severe complication (10/15 perforation cases, 67%). Anticoagulative therapy (OR 6.3, 95% CI 1.4–28.3, P = 0.016) and high procedural difficulty (Shutz category 3: OR 11.5, 95% CI 2.4–54.6, P = 0.002; Shutz category 4: OR 5.9, 95% CI 1.4–23.5, P = 0.012) emerged as independent predictors of severe complications. Conclusions In patients with an early post-ERCP complication, those under anticoagulant therapy and those who underwent difficult ERCP procedures (Schutz 3 or 4) have the highest risk of a severe course.