Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP.

Abstract:

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.

journal_name

Gastrointest Endosc

authors

Nakai Y,Isayama H,Sasahira N,Kogure H,Sasaki T,Yamamoto N,Saito K,Umefune G,Akiyama D,Kawahata S,Matsukawa M,Saito T,Hamada T,Takahara N,Mizuno S,Miyabayashi K,Mohri D,Hirano K,Tada M,Koike K

doi

10.1016/j.gie.2014.06.005

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

119-26

issue

1

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(14)01838-0

journal_volume

81

pub_type

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