The Impact of Difficult Biliary Cannulation on Post-ERCP Pancreatitis: A Secondary Analysis of the Stent versus Indomethacin Trial Dataset.

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
08 Oct 2024
Historique:
received: 25 07 2024
revised: 16 09 2024
accepted: 02 10 2024
medline: 11 10 2024
pubmed: 11 10 2024
entrez: 10 10 2024
Statut: aheadofprint

Résumé

Difficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors. This was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: 1) DBC with high pre-procedure risk for PEP, 2) DBC without high pre-procedure risk, and 3) non-DBC at high pre-procedure risk. In all, 1601 (84.1%) participants experienced DBC, which required a mean of 12 (SD 10) cannulation attempts and mean duration of 14.7 minutes (SD 14.9). PEP rate was highest (20.7%) in DBC with high pre-procedure risk, followed by non-DBC with high pre-procedure risk (13.5%) and then DBC without high pre-procedure risk (8.8%). Increasing number of PD-wire passages (aOR:1.97, 95% CI:1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stenting lowered PEP risk (aOR:0.61, 95% CI:0.44-0.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages. DBC confers higher PEP risk in additive fashion to pre-procedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stenting reduces this risk, even with increasing PD wire passages.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Difficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors.
METHODS METHODS
This was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: 1) DBC with high pre-procedure risk for PEP, 2) DBC without high pre-procedure risk, and 3) non-DBC at high pre-procedure risk.
RESULTS RESULTS
In all, 1601 (84.1%) participants experienced DBC, which required a mean of 12 (SD 10) cannulation attempts and mean duration of 14.7 minutes (SD 14.9). PEP rate was highest (20.7%) in DBC with high pre-procedure risk, followed by non-DBC with high pre-procedure risk (13.5%) and then DBC without high pre-procedure risk (8.8%). Increasing number of PD-wire passages (aOR:1.97, 95% CI:1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stenting lowered PEP risk (aOR:0.61, 95% CI:0.44-0.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages.
CONCLUSIONS CONCLUSIONS
DBC confers higher PEP risk in additive fashion to pre-procedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stenting reduces this risk, even with increasing PD wire passages.

Identifiants

DOI: 10.1016/j.gie.2024.10.003 PMID: 39389431
pubmed: 39389431
pii: S0016-5107(24)03548-X
doi: 10.1016/j.gie.2024.10.003
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Samuel Han (S)

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Jingwen Zhang (J)

Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.

Valerie Durkalski-Mauldin (V)

Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.

Lydia D Foster (LD)

Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.

Jose Serrano (J)

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Gregory A Coté (GA)

Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, Oregon, USA.

Ji Young Bang (JY)

Orlando Health Digestive Health Institute, Orlando Health, Orlando, Florida, USA.

Shyam Varadarajulu (S)

Orlando Health Digestive Health Institute, Orlando Health, Orlando, Florida, USA.

Vikesh K Singh (VK)

Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Mouen Khashab (M)

Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Richard S Kwon (RS)

Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.

James M Scheiman (JM)

Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.

Field F Willingham (FF)

Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.

Steven A Keilin (SA)

Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.

J Royce Groce (JR)

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Peter J Lee (PJ)

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Somashekar G Krishna (SG)

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Amitabh Chak (A)

Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.

Adam Slivka (A)

Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Daniel Mullady (D)

Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.

Vladimir Kushnir (V)

Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.

James Buxbaum (J)

Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, CA, USA.

Rajesh Keswani (R)

Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Timothy B Gardner (TB)

Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, NH, USA.

Sachin Wani (S)

Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Colorado, USA.

Steven A Edmundowicz (SA)

Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Colorado, USA.

Raj J Shah (RJ)

Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Colorado, USA.

Nauzer Forbes (N)

Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Amit Rastogi (A)

Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.

Andrew Ross (A)

Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.

Joanna Law (J)

Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.

Patrick Yachimski (P)

Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Yen-I Chen (YI)

Division of Gastroenterology, McGill University, Montreal, Quebec, Canada.

Alan Barkun (A)

Division of Gastroenterology, McGill University, Montreal, Quebec, Canada.

Zachary L Smith (ZL)

Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Bret T Petersen (BT)

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Andrew Y Wang (AY)

Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA.

John R Saltzman (JR)

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Rebecca L Spitzer (RL)

Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.

Cathie Spino (C)

Department of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

B Joseph Elmunzer (BJ)

Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.

Georgios I Papachristou (GI)

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Georgios.Papachristou@osumc.edu.

Classifications MeSH