Nakahara K, Okuse C, Suetani K, Michikawa Y, Kobayashi S, Otsubo T, Itoh F. Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation. World J Gastroenterol 2014; 20(26): 8617-8623 [PMID: 25024617 DOI: 10.3748/wjg.v20.i26.8617]
Corresponding Author of This Article
Kazunari Nakahara, PhD, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan. nakahara@marianna-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 14, 2014; 20(26): 8617-8623 Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8617
Table 1 Comparison of patient characteristics and diagnoses between the stent and no-stent groups
Stent group (n = 24)
No-stent group (n = 31)
P-value
Age (mean ± SD)
70.8 ± 12.8
72.4 ± 10.0
0.631
Sex (male/female)
11/13
16/15
0.788
History of pancreatitis
0
0
Periampullary diverticulum
10
13
1.000
Choledocholithiasis
15
21
0.778
Cholangiocarcinoma
4
7
0.739
Acute cholecystitis
3
3
1.000
Lymph node metastasis
2
0
0.186
Gallbladder carcinoma
1
1
1.000
Sphincter of Oddi dysfunction
1
1
1.000
Liver metastasis
0
1
1.000
Table 2 Comparison of endoscopic procedures between the stent and no-stent groups
Stent group (n = 24)
No-stent group (n = 31)
P-value
Pancreatic guidewire diameter (0.025 inch or 0.035 inch)
12/12
16/15
1.000
Incision range of EST
Small
3
4
1.000
Medium
21
26
1.000
Large
0
1
1.000
Endoscopic biliary stenting
14
11
0.109
Bile duct stone removal
10
19
0.180
Intraductal ultrasonography
7
10
1.000
Endoscopic nasobiliary drainage
3
6
0.716
Biopsy of the bile duct
2
7
0.271
Cytology of the bile juice
3
6
0.716
Endoscopic naso-gallbladder drainage
3
2
0.643
Peroral cholangioscopy
0
3
0.249
Procedure time (min, mean ± SD)
59.3 ± 19.0
66.4 ± 21.6
0.207
Table 3 Comparison of complications between the stent and no-stent groups n (%)
Stent group (n = 24)
No-stent group (n = 31)
P-value
Overall complications
3 (12.5)
11 (35.5)
0.067
Pancreatitis
1 (4.2)
9 (29.0)
0.031
Bleeding
2 (8.3)
2 (6.5)
1.000
Perforation
0 (0)
0 (0)
Cholangitis
0 (0)
0 (0)
Table 4 Risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients undergoing endoscopic sphincterotomy after biliary cannulation by pancreatic duct guidewire placement
Univariate analysis
Pancreatitis (+) (n = 10)
Pancreatitis (-) (n = 45)
P-value
OR (95%CI)
Age (< 60 yr)
2
9
1.000
1.0 (0.18-5.5)
Female gender
5
23
1.000
0.96 (0.24-3.8)
Periampullary diverticulum
3
20
0.494
0.54 (0.12-2.3)
Pancreatic guidewire (0.035 inch)
4
23
0.729
0.64 (0.16-2.6)
EST incision range (small)
3
4
0.104
4.4 (0.80-24)
No pancreatic duct stenting
9
22
0.031
9.4 (1.1-81)
Endoscopic biliary stenting
3
22
0.318
0.45 (0.10-2.0)
Bile duct stone removal
5
24
1.000
0.88 (0.22-3.5)
Intraductal ultrasonography
4
13
0.479
1.6 (0.40-6.8)
Endoscopic nasobiliary drainage
4
5
0.047
5.3 (1.1-26)
Biopsy of the bile duct
3
6
0.340
2.8 (0.56-14)
Cytology of the bile juice
3
6
0.340
2.8 (0.56-14)
Endoscopic naso-gallbladder drainage
1
4
0.220
3.5 (0.50-24)
Peroral cholangioscopy
1
2
0.459
2.4 (0.20-29)
Procedure time (> 60 min)
5
19
0.733
1.4 (0.35-5.4)
Table 5 Risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients undergoing endoscopic sphincterotomy after biliary cannulation by pancreatic duct guidewire placement
Multivariate analysis
P-value
OR (95%CI)
Incision range of EST ( ≤ small)
0.150
4.7 (0.57-40)
No pancreatic duct stenting
0.045
9.7 (1.1-90)
Endoscopic nasobiliary drainage
0.101
4.6 (0.74-29)
Citation: Nakahara K, Okuse C, Suetani K, Michikawa Y, Kobayashi S, Otsubo T, Itoh F. Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation. World J Gastroenterol 2014; 20(26): 8617-8623