Brief Article
Copyright ©2013 Baishideng Publishing Group Co.
World J Gastrointest Endosc. Apr 16, 2013; 5(4): 160-164
Published online Apr 16, 2013. doi: 10.4253/wjge.v5.i4.160
Table 1 Endoscopic retrograde cholangiopancreatography-degree of difficulty
GradeDiagnosticTherapeutic
Grade 1: standardDeep cannulation, diagnostic samplingBiliary sphincterotomy, stones < 10 mm, stents for leaks and low tumors.
Grade 2: advancedBillroth II diagnostics, minor papilla cannulationStones > 10 mm, hilar tumor stent placement, benign biliary strictures
Grade 3: tertiaryManometry, Whipple, Roux en Y, intraductal endoscopyBillroth II therapeutics, intrahepatic stones, pancreatic therapies
Table 2 Patient demographics
Demographicn (%)
Gender
Males234 (48)
Females252 (52)
Race
Hispanic189 (39)
Non hispanic black179 (37)
White91 (19)
Asian20 (4)
Unspecified7 (1.5)
Alcohol use225 (46)
Other illicit substance use79 (16)
Table 3 Causes of endoscopic retrograde cholangiopancreatography failure with gastroenterologist directed sedation n (%)
Cause
Total number of patients undergoing GDS486
Patient intolerance68 (14)
Cardiopulmonary complications10 (2)
Hypertension6 (1.2)
Hypoxia, hypotension, bradycardia or tachycardia4 (0.8)
Failure to cannulate40 (8)
Food/contrast in lumen8 (1.6)
Roux en Y anatomy2 (0.4)
Esophageal bleeding on entry1 (0.2)
Table 4 Patient variables predicting failure with gastroenterologist directed sedation for endoscopic retrograde cholangiopancreatographies
Patient variablesMSMS failureP valuePatient variables1MSMS failureP value
Substance abuse31130.003
Male131250.01Male1104140.09
Female15712Female115310
RaceRace1
AA79220.001AA61100.06
White4260.8White3860.2
Hispanic14280.001Hispanic13470.04
Asian1510.5Asian1510.7
> 65 yr3720.15> 65 yr13310.16
≤ 65 yr25135 ≤ 65 yr122423
Alcohol use113210.04Alcohol use187110.24
No alcohol use17516No alcohol use117013
Bilirubin-elevated252440.03Bilirubin-elevated1222340.45
Bilirubin-normal14643Bilirubin-normal112624
Table 5 Odds ratios for failure with gastroenterologist directed sedation by indication of the procedure
Indicationn (%)OR (95%CI)Adjusted OR (95%CI)1
Gallstones/cholangitis231 (38)0.6 (0.4, 1.0)0.7 (0.4, 1.3)
All strictures125 (20)1.5 (0.9, 2.4)1.6 (0.9, 2.9)
Benign strictures53 (9)2.2 (1.2, 4.2)2.7 (1.2, 5.7)
Suspected malignancy72 (12)0.9 (0.5, 1.8)0.9 (0.4, 2.0)
Abn LFTs36 (6)0.6 (0.2, 1.6)0.5 (0.12, 2.3)
Pancreatic11 (2)2.7 (0.8, 9.4)3.7 (0.9, 16)
Other7 (1)1.8 (0.4, 9.7)2.5 (0.5, 12.9)
Post cholecystectomy stone/leak24 (4)0.4 (0.1, 1.7)0.3 (0.0, 2.0)
Exchange/incomplete51 (8)2.1 (1.1, 4.0)0.9 (0.3, 2.5)
485
Table 6 Multivariate analysis of predictors of failure with gastroenterologist directed sedation
VariableβcoefficientP valueOR (95%CI)
Grade of procedure (1-3)10.750.0022.1 (1.3, 3.4)
Substance abuse11.030.0012.8 (1.5, 5)
Indication
Strictures0.130.6871.1 (0.6, 2.1)
Gallstone-0.180.5630.8 (0.5, 1.5)
Alcohol use0.330.2671.4 (0.8, 2.5)
Female gender-0.290.330.7 (0.4, 1.3)