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World J Gastroenterol. Sep 28, 2008; 14(36): 5595-5600
Published online Sep 28, 2008. doi: 10.3748/wjg.14.5595
Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography
Kei Ito, Naotaka Fujita, Yutaka Noda, Go Kobayashi, Takashi Obana, Jun Horaguchi, Osamu Takasawa, Shinsuke Koshita, Yoshihide Kanno
Kei Ito, Naotaka Fujita, Yutaka Noda, Go Kobayashi, Takashi Obana, Jun Horaguchi, Osamu Takasawa, Shinsuke Koshita, Yoshihide Kanno, Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi 983-0824, Japan
Author contributions: Ito K designed the study, performed the research and wrote the paper; Fujita N reviewed the paper; Noda Y, Kobayashi G, Obana T, Horaguchi J and Takasawa O performed endoscopic procedures and analyzed data; Koshita S and Kanno Y analyzed data.
Correspondence to: Kei Ito, Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi 983-0824, Japan. keiito@openhp.or.jp
Telephone: +81-22-2521111 Fax: +81-22-2529431
Received: June 10, 2008
Revised: August 18, 2008
Accepted: August 25, 2008
Published online: September 28, 2008
Abstract

AIM: To investigate the frequency and risk factors for acute pancreatitis after pancreatic guidewire placement (P-GW) in achieving cannulation of the bile duct during endoscopic retrograde cholangio-pancreatography (ERCP).

METHODS: P-GW was performed in 113 patients in whom cannulation of the bile duct was difficult. The success rate of biliary cannulation, the frequency and risk factors of post-ERCP pancreatitis, and the frequency of spontaneous migration of the pancreatic duct stent were investigated.

RESULTS: Selective biliary cannulation with P-GW was achieved in 73% of the patients. Post-ERCP pancreatitis occurred in 12% (14 patients: mild, 13; moderate, 1). Prophylactic pancreatic stenting was attempted in 59% of the patients. Of the 64 patients who successfully underwent stent placement, three developed mild pancreatitis (4.7%). Of the 49 patients without stent placement, 11 developed pancreatitis (22%: mild, 10; moderate, 1). Of the five patients in whom stent placement was unsuccessful, two developed mild pancreatitis. Univariate and multivariate analyses revealed no pancreatic stenting to be the only significant risk factor for pancreatitis. Spontaneous migration of the stent was observed within two weeks in 92% of the patients who had undergone pancreatic duct stenting.

CONCLUSION: P-GW is useful for achieving selective biliary cannulation. Pancreatic duct stenting after P-GW can reduce the incidence of post-ERCP pancreatitis, which requires evaluation by means of prospective randomized controlled trials.

Keywords: Endoscopic retrograde cholangio-pancreatography; Pancreatic duct stenting; Acute pancreatitis; Post-endoscopic retrograde cholangio-pancreatography pancreatitis; Biliary cannulation