Frequent Guidewire passage into the Pancreatic duct is an independent risk factor for Post-endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) among high risk individuals: A post-hoc analysis of a randomized controlled trial data.

BACKGROUND: There have been no studies that have systematically evaluated whether previously validated patient and procedural risk factors for PEP remain significant in patients receiving rectal indomethacin.

METHODS: Data from a randomized controlled trial (RCT) of high-risk patients undergoing ERCP who received rectal indomethacin with or without topical epinephrine was evaluated. PEP was defined using the consensus criteria definition. Pancreatic stenting was excluded to avoid confounding results with the role of epinephrine spray. Multivariable logistic regression analysis was used to identify patient and procedural risk factors for PEP.

RESULTS: Among 960 patients enrolled in the RCT, the PEP incidence was 6.4%. An increased risk of PEP was seen with age < 50 years & female gender [OR 2.4 (1.35-4.26)], biliary malignancy [OR 3.51 (1.52-8.1)], >2 guidewire passes to the pancreatic duct (PD) [OR 2.84 (1.43-5.64)] and pancreatic brush cytology [OR 6.3 (1.1-36.9)] whereas a decreased risk of PEP was seen with contrast over guidewire assisted cannulation [OR 0.14 (0.02-0.99)] and use of lactated Ringer's over other fluid types [OR 0.52 (0.27-0.98)]. There was a significant trend observed between the number of guidewire passes into the PD and the risk of PEP (p = 0.002).

CONCLUSIONS: More than two guidewire passes into the PD, pancreatic brush cytology increased while the use of LR decreased the risk of PEP, respectively, among high-risk patients receiving rectal indomethacin. Pancreatic stent placement and/or LR should be considered in those patients in whom there are more than 2 passes of the guidewire into the PD. https://clinicaltrials.gov/ct2/show/NCT02116309. This article is protected by copyright. All rights reserved.