Abstract
Background & aimsAdvanced techniques have been developed to overcome difficult cannulation cases in endoscopic retrograde cholangiopancreatography (ERCP). Pancreatic duct guidewire placement method (PGW) is performed in difficult cannulation cases; it is possible that it places patients at risk of post-ERCP pancreatitis (PEP). The mechanism of PEP is still unclear, but pancreatic duct pressure and injury of pancreatic duct are known causes of PEP. Therefore, we hypothesized a relationship between pancreatic duct diameter and PEP and predicted that PGW would increase the risk of PEP in patients with non-dilated pancreatic ducts. This study aimed to investigate whether PGW increased the risk of PEP in patients with pancreatic duct diameter ≤ 3 mm.MethodsWe analyzed 332 patients with pancreatic duct ≤ 3 mm who performed first time ERCP session. The primary endpoint was the rate of adverse event of PEP. We evaluated the risk of PEP in patients who had undergone PGW compared to those who had not, using the inverse probability of treatment weighting (IPTW) analysis.ResultsPGW was found to be an independent risk factor for PEP by univariate analysis (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.12–5.38; p = 0.03) after IPTW in patients with pancreatic duct diameter ≤ 3 mm. Adjusted for all covariates, PGW remained an independent risk factor for PEP (OR, 3.12; 95% CI, 1.33–7.33; p = 0.01).ConclusionOur results indicate that PGW in patients with pancreatic duct diameter ≤ 3 mm increases the risk of PEP.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreatic biliary disease, but post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common adverse event, which can lead to death [1,2,3]
PGW was found to be an independent risk factor for post-ERCP pancreatitis (PEP) by univariate analysis after inverse probability of treatment weighting (IPTW) in patients with pancreatic duct diameter 3 mm
Adjusted for all covariates, PGW remained an independent risk factor for PEP (OR, 3.12; 95% confidence interval (95% CI), 1.33–7.33; p = 0.01)
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreatic biliary disease, but post-ERCP pancreatitis (PEP) is the most common adverse event, which can lead to death [1,2,3]. The pancreatic guidewire placement method (PGW) is one such technique, reported by Dumonceau in a patient who underwent Billroth I anastomosis [7]. There is no risk of PEP with PGW compared to conventional cannulation techniques [10, 11]; Sasahira et al reported that leaving the guidewire in the pancreatic duct might cause irritation and injury of the pancreatic duct and parenchyma [12]. Advanced techniques have been developed to overcome difficult cannulation cases in endoscopic retrograde cholangiopancreatography (ERCP). Pancreatic duct guidewire placement method (PGW) is performed in difficult cannulation cases; it is possible that it places patients at risk of post-ERCP pancreatitis (PEP). This study aimed to investigate whether PGW increased the risk of PEP in patients with pancreatic duct diameter 3 mm
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