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. 2018 Jan 10;13(1):e0190379.
doi: 10.1371/journal.pone.0190379. eCollection 2018.

Risk of pancreatitis after pancreatic duct guidewire placement during endoscopic retrograde cholangiopancreatography

Yuki Ishikawa-Kakiya  1 , Masatsugu Shiba  1 , Hirotsugu Maruyama  1 , Kunihiro Kato  1 , Shusei Fukunaga  1 , Satoshi Sugimori  1 , Koji Otani  1 , Shuhei Hosomi  1 , Fumio Tanaka  1 , Yasuaki Nagami  1 , Koichi Taira  1 , Hirokazu Yamagami  1 , Tetsuya Tanigawa  1 , Toshio Watanabe  1 , Yasuhiro Fujiwara  1
Affiliations

Risk of pancreatitis after pancreatic duct guidewire placement during endoscopic retrograde cholangiopancreatography

Yuki Ishikawa-Kakiya et al. PLoS One. .

Abstract

Background & aims: Advanced techniques have been developed to overcome difficult cannulation cases in endoscopic retrograde cholangiopancreatography (ERCP). Pancreatic duct guidewire placement method (PGW) is performed in difficult cannulation cases; it is possible that it places patients at risk of post-ERCP pancreatitis (PEP). The mechanism of PEP is still unclear, but pancreatic duct pressure and injury of pancreatic duct are known causes of PEP. Therefore, we hypothesized a relationship between pancreatic duct diameter and PEP and predicted that PGW would increase the risk of PEP in patients with non-dilated pancreatic ducts. This study aimed to investigate whether PGW increased the risk of PEP in patients with pancreatic duct diameter ≤ 3 mm.

Methods: We analyzed 332 patients with pancreatic duct ≤ 3 mm who performed first time ERCP session. The primary endpoint was the rate of adverse event of PEP. We evaluated the risk of PEP in patients who had undergone PGW compared to those who had not, using the inverse probability of treatment weighting (IPTW) analysis.

Results: PGW was found to be an independent risk factor for PEP by univariate analysis (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.12-5.38; p = 0.03) after IPTW in patients with pancreatic duct diameter ≤ 3 mm. Adjusted for all covariates, PGW remained an independent risk factor for PEP (OR, 3.12; 95% CI, 1.33-7.33; p = 0.01).

Conclusion: Our results indicate that PGW in patients with pancreatic duct diameter ≤ 3 mm increases the risk of PEP.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diagram of the study design.
ERCP, endoscopic retrograde cholangiopancreatography PGW, pancreatic guidewire placement method.
See this image and copyright information in PMC

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