TY - JOUR
T1 - Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP
AU - Nakai, Yousuke
AU - Isayama, Hiroyuki
AU - Sasahira, Naoki
AU - Kogure, Hirofumi
AU - Sasaki, Takashi
AU - Yamamoto, Natsuyo
AU - Saito, Kei
AU - Umefune, Gyotane
AU - Akiyama, Dai
AU - Kawahata, Shuhei
AU - Matsukawa, Miho
AU - Saito, Tomotaka
AU - Hamada, Tsuyoshi
AU - Takahara, Naminatsu
AU - Mizuno, Suguru
AU - Miyabayashi, Koji
AU - Mohri, Dai
AU - Hirano, Kenji
AU - Tada, Minoru
AU - Koike, Kazuhiko
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background Wire-guided cannulation (WGC) was reported to decrease post-ERCP pancreatitis (PEP), but risk factors for PEP in WGC are not fully elucidated. Objective To evaluate the incidence and risk factors of PEP in WGC. Design Single-center retrospective study. Setting Academic center. Patients A total of 800 consecutive patients with a native papilla. Interventions Biliary therapeutic ERCP by using WGC. Main Outcome Measurements The rate of PEP and its risk factors. Results Biliary cannulation was successful by using WGC alone in 70.5%, and the final cannulation rate was 96.1%. Unintentional guidewire insertion and contrast material injection into the pancreatic duct (PD) during cannulation occurred in 55.3% and 21.8%, respectively. The incidence of PEP was 9.5% (mild 5.6%, moderate 2.9%, severe 1.0%). Multivariate analysis revealed a common bile duct (CBD) diameter of <9 mm (odds ratio [OR] 2.03; P =.006) and unintentional guidewire insertion into the PD (OR 2.25; P =.014) as risk factors for PEP. PD opacification was not a risk factor for PEP (OR 1.15; P =.642), but the incremental increase of the PEP rate was seen in patients with CBDs <9 mm: 4.6% without any PD manipulation, 8.3% with contrast material alone, 16.9% with guidewire alone, and 22.1% with both contrast material and guidewire. Limitations Retrospective design in a single center. Conclusion Unintentional PD manipulation was not uncommon in WGC. Guidewire insertion into the PD and a small CBD were risk factors for PEP in biliary therapeutic ERCP with the use of WGC.
AB - Background Wire-guided cannulation (WGC) was reported to decrease post-ERCP pancreatitis (PEP), but risk factors for PEP in WGC are not fully elucidated. Objective To evaluate the incidence and risk factors of PEP in WGC. Design Single-center retrospective study. Setting Academic center. Patients A total of 800 consecutive patients with a native papilla. Interventions Biliary therapeutic ERCP by using WGC. Main Outcome Measurements The rate of PEP and its risk factors. Results Biliary cannulation was successful by using WGC alone in 70.5%, and the final cannulation rate was 96.1%. Unintentional guidewire insertion and contrast material injection into the pancreatic duct (PD) during cannulation occurred in 55.3% and 21.8%, respectively. The incidence of PEP was 9.5% (mild 5.6%, moderate 2.9%, severe 1.0%). Multivariate analysis revealed a common bile duct (CBD) diameter of <9 mm (odds ratio [OR] 2.03; P =.006) and unintentional guidewire insertion into the PD (OR 2.25; P =.014) as risk factors for PEP. PD opacification was not a risk factor for PEP (OR 1.15; P =.642), but the incremental increase of the PEP rate was seen in patients with CBDs <9 mm: 4.6% without any PD manipulation, 8.3% with contrast material alone, 16.9% with guidewire alone, and 22.1% with both contrast material and guidewire. Limitations Retrospective design in a single center. Conclusion Unintentional PD manipulation was not uncommon in WGC. Guidewire insertion into the PD and a small CBD were risk factors for PEP in biliary therapeutic ERCP with the use of WGC.
UR - http://www.scopus.com/inward/record.url?scp=84922927665&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2014.06.005
DO - 10.1016/j.gie.2014.06.005
M3 - Article
C2 - 25442080
AN - SCOPUS:84922927665
SN - 0016-5107
VL - 81
SP - 119
EP - 126
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 1
ER -