Contrast-free ERCP in patients with primary sclerosing cholangitis

Risk of cholangitis after ERCP increases in patients with PSC due to incomplete biliary drainage.It is an expected situation,especially in patients whose entire biliary tree is filled 'non-selectively'.It was investigated whether the risk of cholangitis after ERCP was different in patients with PSC who underwent 'selective' cholangiography after locating the branch to be drained with a guide wire under MRCP guidance, and who underwent endoscopic treatment without any contrast;under MRCP guidance. Cholangitis conditions of patients with PSK who underwent endoscopic treatment with selective cholangiography and contrast-free ERCP in the ERCP unit of our hospital between January 2018-May 2023 were evaluated retrospectively.Antibiotic prophylaxis was given to each patient before endoscopic procedure.Endoscopic treatment was performed by dilation and nasobiliary drainage,dilation and plastic stent placement,depending on the patient's anatomy.Cholangitis was defined as prolonged hospitalization due to clinical cholangitis findings,laboratory findings,antibiotic use after the procedure. 81 procedures performed on 30 patients;43(53.1%)were without contrast and 38(46.9%)were with selective contrast. Non-selective cholangiography was not performed.Cholangitis was found to develop in 5(11.6%)which contrast was not administered and in 3(7.9%)which selective cholangiography was performed(p=0.717).ERCP had previously been performed in 68 procedures and cholangitis developed in 6(8.8%),while cholangitis developed in 2(15.4%)of 13 procedure which ERCP had not been performed before.First procedure or previous ERCP did not affect the risk of cholangitis(p=0.608).There were intrahepatic stones in 12(14.8%)of 81. Cholangitis developed in 2(16.7%)of stone removal procedures.When patients with stones were excluded from the study,cholangitis developed in 5(12.8%)of 39 procedures in which contrast-free ERCP was performed,while cholangitis developed in 1(3.3%)of 30 which selective contrast was administered(p=0.223).Presence of concomitant intrahepatic stones did not affect the risk of cholangitis(p=0.338). Contrast free ERCP and selective cholangiography performed in PSC patients have similar risk of cholangitis.A study comparing these methods with non-selective cholangiography will better reveal the effectiveness of these methods.