Risk Factors and Techniques Affecting Surgical Outcome of Therapeutic Endoscopic Retrograde Cholangiopancreatography Difficulties

Objective: To analyze the therapeutic endoscopic retrograde cholangio pancreatography (ERCP) difficulties and complications experienced by a general surgeon and identify risk factors and technique affecting surgical outcome. Material and Method: A retrospective review was carried out in 88 consecutive ERCP operated with four different indications on patients in Nakornping General Hospital by a surgeon trained from Nippon Medical School, Japan. Results: The patients average age was 57.2 years. Fifty-four patients had common bile duct stone and 43 of them were successfully removed. Endoscopic sphincterotomy (EST) was the most frequent procedure needed to combine with the stone extraction(23 in 43). Twenty-two distal common bile duct obstructions unable to be diagnosed by ultrasound or computed tomography were operated on and found to be unvarying propor-tion of tumor, stone or stricture. Among these 6 biopsy and 12 treatments were concurrently made. Eight bile fistula and four cholangitis were indicated for endoscopic drainage. Only one serious bleeding was compli-cated. Two perforations were discovered in the present series and none required laparotomy repair of duodenum. Eighteen of the 88 failed to be operated on and most of them were within first four-month learning curve. Duodenal diverticulum was a common failure factor. The pre-procedure unknown diagnosis relates t