Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial
- Abstract
- BACKGROUND: Among the procedure-related factors associated with post-ERCP pancreatitis, selective cannulation of the common bile duct by insertion of a guidewire may be associated with fewer complications than conventional methods of cannulation with contrast injection to access the bile duct. However, the results of studies regarding the usefulness of wire-guided cannulation (WGC) are conflicting. OBJECTIVE: This prospective randomized trial was designed to determine whether WGC reduces the rate of post-ERCP pancreatitis. DESIGN: A prospective randomized controlled trial. SETTING: Tertiary-care academic medical center. PATIENTS: A total of 300 consecutive patients with native papilla and pancreaticobiliary disease who were candidates for therapeutic ERCP were randomized from June 2006 to May 2007. INTERVENTIONS: WGC without contrast injection or conventional cannulation with contrast injection. MAIN OUTCOME MEASUREMENTS: Post-ERCP pancreatitis, risk factors, and procedure-related complications were evaluated prospectively. RESULTS: A total of 3 patients (2%) in the WGC group and 17 patients (11.3%) in the conventional group had post-ERCP pancreatitis (P = .001). Among the cases of acute pancreatitis in the WGC group, 2 patients with suspected sphincter of Oddi dysfunction (SOD) and unintentional main pancreatic duct (PD) guidewire cannulation showed post-ERCP pancreatitis despite the use of WGC. In multivariate analysis, WGC was a protective factor (odds ratio 0.1; 95% CI, 0.024-0.490, P = .004), whereas female sex and SOD were risk factors for post-ERCP pancreatitis. LIMITATION: Our study population was a low-risk cohort. CONCLUSIONS: WGC is associated with a lower rate of post-ERCP pancreatitis. However, WGC may not prevent post-ERCP pancreatitis in patients with suspected SOD and unintentional PD guidewire cannulation.
- All Author(s)
- T. H. Lee
; D. H. Park
; J. Y. Park
; E. O. Kim
; Y. S. Lee
; J. H. Park
; S. H. Lee
; I. K. Chung
; H. S. Kim
; S. H. Park
; S. J. Kim
- Issued Date
- 2009
- Type
- Article
- Keyword
- Adult; Catheterization/*instrumentation/*methods; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects; *Common Bile Duct; Female; Humans; Male; Middle Aged; Pancreatitis/epidemiology/*prevention & control; Prospective Studies
- Publisher
- American Society for Gastrointestinal Endoscopy
- ISSN
- 0016-5107
- Citation Title
- Gastrointestinal Endoscopy
- Citation Volume
- 69
- Citation Number
- 3 Pt 1
- Citation Start Page
- 444
- Citation End Page
- 449
- Language(ISO)
- eng
- DOI
- 10.1016/j.gie.2008.04.064
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/1079
- 공개 및 라이선스
-
- 파일 목록
-
Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.