Document Detail


Guidewire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients.
MedLine Citation:
PMID:  22075192     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Guidewire (GW) cannulation can reduce the risk of post-ERCP pancreatitis (PEP) by avoiding the opacification of the main pancreatic duct.
OBJECTIVE: To compare the effects of conventional contrast ERCP and GW cannulation of the common bile duct on the rate of PEP in low- and high-risk patients.
DESIGN: Prospective, comparative-intervention single-center study.
SETTING: Tertiary referral center.
PATIENTS: Patients with biliary disease with an intact papilla were prospectively examined by ERCP.
INTERVENTIONS: Biliary cannulation using a sphincterotome with contrast injection (ConI) or a hydrophilic GW without contrast injection.
MAIN OUTCOME MEASUREMENTS: Pancreatitis rate in the GW group and the contrast injection (ConI) group.
RESULTS: PEP occurred in 60 of 1249 patients (4.8%), 35 of 678 (5.2%) in the GW group and 25 of 571 (4.4%) in the ConI group (not significant). The overall rate of PEP was significantly higher in high-risk patients (12.2%) than in low-risk patients (3.5%) (P < .001), but was similar for the 2 techniques within each of these 2 groups. In patients with unintended main pancreatic duct (MPD) cannulation or opacification, the rate of PEP was not significantly different with the GW (15.2%) and ConI (8.4%) techniques but was associated with a significantly higher rate of pancreatitis (11.9%) than in patients in whom the contrast medium or GW did not enter the MPD (3.5%) (P < .001). Multivariate analysis indicated that more than 10 papillary cannulation attempts, MPD cannulation or opacification, suspected sphincter of Oddi dysfunction, and precut methods were significant risk factors independently associated with PEP.
LIMITATIONS: Lack of randomization.
CONCLUSIONS: For selective cannulation of the CBD, the risk of inducing PEP is similar with the ConI and GW techniques in high-risk and low-risk patients. Any manipulation of the MPD must be considered a high-risk factor for PEP, such as multiple attempts on the papilla or use of the precut method.
Authors:
Alberto Mariani; Antonella Giussani; Milena Di Leo; Sabrina Testoni; Pier Alberto Testoni
Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article     Date:  2011-11-09
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  75     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-17     Completed Date:  2012-05-25     Revised Date:  2013-05-07    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  339-46     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Catheterization / adverse effects*,  methods*
Chi-Square Distribution
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*,  methods
Common Bile Duct
Contrast Media / adverse effects*,  diagnostic use
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Pancreatitis / etiology*
Prospective Studies
Severity of Illness Index
Sphincterotomy, Endoscopic / adverse effects
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections
Comment In:
Gastrointest Endosc. 2012 Jul;76(1):229-30; author reply 230   [PMID:  22726494 ]
Gastrointest Endosc. 2013 Feb;77(2):313-4   [PMID:  23317695 ]
Gastrointest Endosc. 2013 Feb;77(2):314-5   [PMID:  23317696 ]
Gastrointest Endosc. 2012 Aug;76(2):468; author reply 468   [PMID:  22817804 ]
Gastrointest Endosc. 2012 Oct;76(4):919-20; author reply 920-1   [PMID:  22985649 ]
Endoscopy. 2013;45(4):296-9   [PMID:  23440584 ]
Gastrointest Endosc. 2012 Jul;76(1):223; author reply 224   [PMID:  22726486 ]

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