Safety and Efficacy of a Small J-Tipped Guidewire for Pancreatic Duct Endoscopic Intervention.

Sumio Hirose,Yoshimitsu Fukasawa,Hiroshi Hayakawa,Nobuyuki Enomoto,Satoshi Kawakami,Hiroko Shindo,Ei Takahashi,Tadashi Sato,Shinichi Takano,Mitsuharu Fukasawa,Yudai Yokota,Makoto Kadokura

doi:10.1155/2019/8947614

Sumio Hirose, Yoshimitsu Fukasawa + Show 10 more

Open Access

https://doi.org/10.1155/2019/8947614

Copy DOI

Abstract

Background and Aims The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention. Methods This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW. Results The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22–0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30–0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61–8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09–0.85, P = 0.02). Conclusions Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.

Highlights

Endoscopic transpapillary interventions to the pancreatic duct, such as a detailed examination for pancreatic diseases and stenting for pancreatic duct stricture, became more common in recent years. pancreatic duct endoscopic intervention is usually performed with guidewire (GW) placed in the pancreatic duct, the insertion of a GW itself is difficult because the pancreatic duct is anatomically more complicated with advanced curves and strictures compared with the biliary duct [1]
Pancreatic duct endoscopic intervention is usually performed with guidewire (GW) placed in the pancreatic duct, the insertion of a GW itself is difficult because the pancreatic duct is anatomically more complicated with advanced curves and strictures compared with the biliary duct [1]
We have previously reported that ERCP with a GW inserted into the pancreatic duct results in a significantly higher incidence of post-ERCP pancreatitis (PEP) compared with procedures without a GW insertion into the pancreatic duct, regardless of the use of a pancreatic stent [11]

Summary

Introduction

Endoscopic transpapillary interventions to the pancreatic duct (pancreatic duct endoscopic intervention), such as a detailed examination for pancreatic diseases and stenting for pancreatic duct stricture, became more common in recent years. pancreatic duct endoscopic intervention is usually performed with guidewire (GW) placed in the pancreatic duct, the insertion of a GW itself is difficult because the pancreatic duct is anatomically more complicated with advanced curves and strictures compared with the biliary duct [1]. We have previously reported that ERCP with a GW inserted into the pancreatic duct results in a significantly higher incidence of PEP compared with procedures without a GW insertion into the pancreatic duct, regardless of the use of a pancreatic stent [11]. This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small Jtipped GW and 180 cases using the angle-tipped GW. The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis

Objectives

Methods

Results

Conclusion