BACKGROUND AND STUDY AIMS: Endoscopic pancreatic sphincterotomy is indispensable for many therapeutic endoscopic maneuvers, but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). In this study, this subgroup of patients was investigated in order to identify risk factors and protective factors. PATIENTS AND METHODS: A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria. Charts were examined for indications, endoscopic technique, and outcomes, including pancreatitis. RESULTS: A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period. Indications for sphincterotomy included chronic pancreatitis (n = 398), access for tissue sampling (n = 52), acute recurrent pancreatitis (n = 45), transpapillary drainage of a pancreatic pseudocyst (n = 32), precut access to the common bile duct (n = 29), and others (n = 16). Pancreatic duct drainage was performed in 69.1 % of the procedures (nasopancreatic catheter, n = 290, or pancreatic stent placement, n = 105). Post-ERCP pancreatitis occurred in 69 cases (12.1 %) and was severe in 10. The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis, while an elevated C-reactive protein level, pancreatic ductal stones, sphincterotomy at only the major papilla, and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk. CONCLUSIONS: This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis. In addition to providing further definition of which patients are at risk, it also suggests that pancreatic duct drainage is an independently significant protective maneuver.
BACKGROUND AND STUDY AIMS: Endoscopic pancreatic sphincterotomy is indispensable for many therapeutic endoscopic maneuvers, but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). In this study, this subgroup of patients was investigated in order to identify risk factors and protective factors. PATIENTS AND METHODS: A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria. Charts were examined for indications, endoscopic technique, and outcomes, including pancreatitis. RESULTS: A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period. Indications for sphincterotomy included chronic pancreatitis (n = 398), access for tissue sampling (n = 52), acute recurrent pancreatitis (n = 45), transpapillary drainage of a pancreatic pseudocyst (n = 32), precut access to the common bile duct (n = 29), and others (n = 16). Pancreatic duct drainage was performed in 69.1 % of the procedures (nasopancreatic catheter, n = 290, or pancreatic stent placement, n = 105). Post-ERCP pancreatitis occurred in 69 cases (12.1 %) and was severe in 10. The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis, while an elevated C-reactive protein level, pancreatic ductal stones, sphincterotomy at only the major papilla, and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk. CONCLUSIONS: This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis. In addition to providing further definition of which patients are at risk, it also suggests that pancreatic duct drainage is an independently significant protective maneuver.
Authors: Yong Won Joo; Jai Hoon Yoon; Seung Chul Cho; Kang Nyeong Lee; Na Rae Ha; Hang Lak Lee; Oh Young Lee; Byung Chul Yoon; Ho Soon Choi; Joon Soo Hahm; Dong Hoo Lee; Min Ho Lee Journal: Korean J Intern Med Date: 2009-08-26 Impact factor: 2.884
Authors: S M Jeurnink; P D Siersema; E W Steyerberg; J Dees; J W Poley; J Haringsma; E J Kuipers Journal: Surg Endosc Date: 2011-04-01 Impact factor: 4.584
Authors: Samuel Han; Augustin R Attwell; Philip Tatman; Steven A Edmundowicz; Hazem T Hammad; Mihir S Wagh; Sachin Wani; Raj J Shah Journal: Pancreas Date: 2021-03-01 Impact factor: 3.243
Authors: Mahya Faghih; Amitasha Sinha; Robert A Moran; Elham Afghani; Yuval A Patel; Andrew C Storm; Ayesha Kamal; Venkata S Akshintala; Atif Zaheer; Anthony N Kalloo; Vivek Kumbhari; Mouen A Khashab; Vikesh K Singh Journal: Endosc Int Open Date: 2018-07-04