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

Yousuke Nakai, Hiroyuki Isayama, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Natsuyo Yamamoto, Kei Saito, Gyotane Umefune, Dai Akiyama, Shuhei Kawahata, Miho Matsukawa, Tomotaka Saito, Tsuyoshi Hamada, Naminatsu Takahara, Suguru Mizuno, Koji Miyabayashi, Dai Mohri, Kenji Hirano, Minoru Tada, Kazuhiko Koike
Gastrointestinal Endoscopy 2015, 81 (1): 119-26

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.

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