Older age, longer procedures and tandem endoscopic-ultrasound as risk factors for post-endoscopic retrograde cholangiopancreatography bacteremia

Table 1 Patients' and procedures' characteristics

	All ERCPs (n = 626)	PEB (n = 23)	Non-PEB (n = 603)	P value
Age (yr)	66.49 ± 15.4	71.74 ± 14.2	66.29 ± 15.4	0.095a
Male gender [n (%)]	291 (46.5%)	11 (47.8%)	280 (46.4%)	0.896b
Native papilla [n (%)]	284 (45.4%)	14 (60.9%)	270 (44.9%)	0.130b
Abdominal malignancy at presentation [n (%)]	193 (30.8%)	9 (39.1%)	184 (30.5%)	0.380b
Non	433 (69.2%)	14 (60.9%)	419 (69.5%)	0.634b
Pancreas	147 (23.5%)	6 (26.1%)	141 (23.4%)
Cholangiocarcinoma	24 (3.8%)	2 (8.7%)	22 (3.6%)
Liver metastases	14 (2.2%)	1 (4.3%)	13 (2.2%)
Other abdominal	8 (1.3%)	0 (0%)	8 (1.3%)
s/p liver transplantation	44 (7.0%)	0 (0%)	44 (7.3%)	0.179b
Indications [n (%)]				0.337b
Choledocholithiasis	201 (32.1%)	7 (30.4%)	194 (32.2%)
Chronic pancreatitis	23 (3.7%)	2 (8.7%)	21 (3.5%)
Obstructive malignancy	98 (15.7%)	6 (26.1%)	92 (15.3%)
Benign bile duct stricture	130 (20.8%)	2 (8.7%)	128 (21.2%)
Elective stent replacement	156 (24.9%)	6 (26.1%)	150 (24.9%)
Surgical complications	18 (2.9%)	0 (0%)	18 (3.0%)
Procedure characteristics
Duration (minutes)	29.09 ± 25.3	40.87 ± 42.7	28.64 ± 24.3	0.02a
Sphincterotomy [n (%)]	279 (44.6%)	15 (65.2%)	264 (43.8%)	0.136b
Pre-cut [n (%)]	46 (7.3%)	2 (8.7%)	44 (7.3%)	0.772b
TTS dilation [n (%)]	33 (5.3%)	0 (0%)	33 (5.5%)	0.249b
Pancreatic stent [n (%)]	52 (8.3%)	2 (8.7%)	50 (8.3%)	0.945b
Tandem EUS/ERCP [n (%)]	42 (6.7%)	5 (21.7%)	37 (6.1%)	0.003b
Tandem EUS/ERCP + FNA [n (%)]	13 (2.1%)	4 (17.4%)	9 (1.5%)	< 0.001b

^aStudent's t-test;

^bPearson χ² as appropriate.

ERCP: Endoscopic retrograde cholangiopancreatography; PEB: Post endoscopic retrograde cholangiopancreatography bacteremia; s/p: Status post; TTS: Through the scope; EUS: Endoscopic ultrasound; FNA: Fine needle aspiration.

Table 2 Univariate and multivariate logistic regression

	Univariate logistic regression			Multivariate logistic regression
Variable	Exp (b)	95%CI	P value	Exp (b)	95%CI	P value
Gender (male vs female)	1.057	0.459-2.434	0.444
Age at ERCP (yr)	1.027	0.995-1.060	0.096
Native papilla (Yes vs No)	1.913	0.815-4.487	0.136
Obstructive abdominal malignancy (Yes vs No)	1.464	0.622-3.443	0.382
Naïve obstructive malignancy (Yes vs No)	1.960	0.753-5.104	0.168
Antibiotic prophylaxis (Yes vs No)	0.324	0.075-1.399	0.131	0.224	0.087-1.775	0.224
Appropriateness (indicated, appropriate, not indicated)	1.048	0.514-2.135	0.898
Tandem EUS/ERCP (Yes vs No)	4.130	1.494-12.084	0.007
Tandem EUS/ERCP with FNA (Yes vs No)	13.894	3.928-49.145	< 0.001	14.528	3.571-59.095	< 0.001
Sphincterotomy (Yes vs No)	2.408	1.006-5.764	0.051
Precut (Yes vs No)	1.210	0.275-5.329	0.801
TTS dilation (Yes vs No)	0.000	-	1.000
ERCP duration (min)	1.011	1.001-1.022	0.034
Age at ERCP ≥ 75 years (Yes vs No)	3.722	1.552-8.925	0.003	3.780	1.519-9.408	0.004
ERCP duration ≥ 60 minutes (Yes vs No)	3.933	1.438-10.432	0.006	5.396	1.86-15.656	0.002

Dependent variable: Outcome of post endoscopic retrograde cholangiopancreatography bacteremia; ERCP: Endoscopic retrograde cho-langiopancreatography; EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; TTS: Through the scope.