Impact of changing our cannulation method on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis after pancreatic guidewire placement

Table 1 Patient characteristics and endoscopic procedures used in pancreatic guidewire placement

	Total (n = 142)	Cannulation method
		CI using a single-lumen catheter (n = 104)	WGC using a double-lumen catheter (n = 38)	P value
Mean age (mean ± SD)	72.7 (11.5)	68.5 (10.9)	75.3 (13.2)
Male sex (%)	71 (50)	48 (46)	23 (61)	0.18
Periampullary diverticulum (%)	28 (20)	21 (20)	7 (18)	1.00
Diagnosis (%)
Choledocholithiasis	55 (39)	33 (32)	22 (58)	0.01
Biliary cancer	33 (23)	25 (24)	8 (21)	0.90
Pancreatic cancer	24 (17)	20 (19)	4 (11)	0.33
Ampullary cancer	4 (2.8)	4 (3.8)	0 (0)	0.57
ERCP maneuvers (%)
Biliary sphincterotomy	69 (49)	50 (48)	19 (50)	0.99
Transpancreatic sphincterotomy	2 (1.4)	1 (0.96)	1 (2.6)	0.87
Papillary ballon dilatation	4 (2.8)	4 (4)	0 (0)	0.63
Bile duct stone removal	20 (14)	14 (13)	6 (16)	0.91
Biliary stenting	55 (39)	36 (35)	19 (50)	0.14
Pancreatic stenting	9 (6.3)	8 (7.7)	1 (2.6)	0.50

ERCP: Endoscopic retrograde cholangiopancreatography; CI: Contrast injection; WGC: Wire-guided cannulation.

Table 2 Outcome of pancreatic guidewire placement n (%)

	Total (n = 142)	Cannulation method
		CI using a single-lumen catheter (n = 104)	WGC using a double-lumen catheter (n = 38)	P value
Successful biliary cannulation	98 (69)	69 (66)	29 (76)	0.35
Post-ERCP pancreatitis	22 (16)	21 (20)	1 (2.6)	0.012

ERCP: Endoscopic retrograde cholangiopancreatography; CI: Contrast injection; WGC: Wire-guided cannulation.

Table 3 Impact of contrast injection using a single-lumen on post-endoscopic retrograde cholangiopancreatography pancreatitis after pancreatic guidewire placement according to multivariate analysis

	Model 1 crude OR (95% C.I.)	Model 2adjusted OR (95% C.I.)	Model 3adjusted OR (95% C.I.)
CI using a single-lumen catheter	9.4 (1.2-72)a	10.2 (1.3-83)a	10.8 (1.3-88)a
Female		1.5 (0.56-3.9)	1.4 (0.50-3.7)
< 50 yr		6.8 (0.79-59)	6.1 (0.67-56)
Failed cannulation			1.2 (0.30-4.9)
Bile duct stone removal			1.9 (0.46-7.5)
Pancreatic brush cytology			0.55 (0.061-5.0)
Biliary sphincterotomy			1.3 (0.36-4.7)

^aP < 0.05. CI: Contrast injection; OR: Odds ratio; C.I.: Confidence interval.

Table 4 Study on pancreatic guidewire placement

Primary author	Study design	No. of patients	Cannulation method	Success rate fo biliary cannulation	Incidence fo post-ERCP pancreatitis
Maeda[8]	RCT	Control (n = 26), attempted PGW (n = 27)	CI	54%, 93%	0%, 0%
Ito[9]	OS	PGW (n = 113)	CI	73%	12%
Herreros de Tejada[10]	RCT	Control (n = 87), attempted PGW (n = 76)	WGC	56%, 47%	8%, 17%
Ito[11]	RCT	PGW with no-PS (n = 35), PGW with PS (n = 35)	CI	94%, 80%	23%, 2.9%
Present study	OS	PGW (n = 142)	CI/WGC (104/38)	69% (CI 66%, WGC 76%)	16% (CI 20%, WGC 2.6%)

RCT: Randomized controlled trial; OS: Observational study; PGW: Pancreatic guidewire placement; PS: Pancreatic stent; CI: Contrast injection; WGC: Wire-guided cannulation.