Post-ERCP pancreatitis: association with urographic visualization during ERCP.

To investigate the possible association of urographic visualization and acinarization of contrast material with postprocedure pancreatitis, 140 consecutive endoscopic retrograde cholangiopancreatograms (ERCP) with pancreatic duct filling were reviewed. Urographic visualization was identified in 29 patients (21%); pancreatitis developed in 13 of these patients (45%). Pancreatitis occurred in five of 111 patients (4%) without urographic visualization. Of 19 patients who demonstrated both acinarization and urographic visualization, ten (53%) had postprocedure pancreatitis. Twenty-six patients exhibited acinarization without urographic visualization; one (4%) had pancreatitis. Urographic visualization during ERCP is probably more common than generally recognized and indicates patients who are at high risk for postprocedure pancreatitis. Although acinarization accompanied by urographic visualization is associated with a high risk of pancreatitis, acinarization alone was not associated with this complication in this study. Detection of renal opacification during ERCP requires close scrutiny of films is best accomplished on overhead radiographs.