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Difficult Biliary Cannulation from the Perspective of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Identifying the Optimal Timing for the Rescue Cannulation Technique

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Author(s)
Yoon Suk LeeChang Min ChoKwang Bum ChoJun HeoMin Kyu JungSung Bum KimKook Hyun KimTae Nyeun KimDong Wook LeeJimin HanHo Gak KimDaejin KimHyunsoo Kim
Keimyung Author(s)
Cho, Kwang Bum
Department
Dept. of Internal Medicine (내과학)
Journal Title
Gut and Liver
Issued Date
2021
Volume
15
Issue
3
Keyword
PancreatitisCholangiopancreatography, endoscopic retrogradeRisk factorsDecision treesPractice guideline
Abstract
Background/Aims:
Recently, the European Society of Gastrointestinal Endoscopy (ESGE) proposed criteria for "difficult biliary cannulation" during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to investigate the clinical relevance of the ESGE criteria from the perspective of post-ERCP pancreatitis (PEP).

Methods:
An ERCP database was prospectively maintained between November 2014 and December 2015 across six teaching hospitals in South Korea. The ESGE criteria (biliary cannulation time, the number of cannulation attempts, and inadvertent pancreatic duct [PD] manipulation) were recorded in this database as well as other technical factors. Logistic regression analysis was used to identify risk factors for PEP. Then, the PEP prediction model was investigated using decision tree analysis.

Results:
We analyzed 1,067 consecutive patients with naïve papilla. The overall rate of PEP was 6.6%. Multivariate analysis revealed that female sex (odds ratio [OR], 1.860; 95% confidence interval [CI], 1.124 to 3.078), a selective biliary cannulation duration >5 minutes (OR, 3.282; 95% CI, 1.641 to 6.566), and inadvertent PD manipulation (OR, 2.614; 95% CI, 1.480 to 4.617) were significant factors affecting PEP. Decision tree analysis revealed that biliary cannulation time (χ2=49.857, p<0.001) and inadvertent PD manipulation (χ2=8.556, p=0.010) were decisive factors. PEP occurred in 3.9%, 11.8%, and 16.2% of patients with biliary cannulation duration lasting 3 to 5 minutes, >5 minutes, and >5 minutes with inadvertent PD manipulation, respectively.

Conclusions:
Biliary cannulation time and inadvertent PD manipulation could be relevant indicators of PEP, and 5 minutes might be used as a cutoff value for the implementation of the rescue cannulation technique.
Keimyung Author(s)(Kor)
조광범
Publisher
School of Medicine (의과대학)
Citation
Yoon Suk Lee et al. (2021). Difficult Biliary Cannulation from the Perspective of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Identifying the Optimal Timing for the Rescue Cannulation Technique. Gut and Liver, 15(3), 459–465. doi: 10.5009/gnl19304
Type
Article
ISSN
2005--1212
Source
https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl19304#
DOI
10.5009/gnl19304
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43504
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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