Tanikawa T, Miyake K, Kawada M, Ishii K, Fushimi T, Urata N, Wada N, Nishino K, Suehiro M, Kawanaka M, Shiraha H, Haruma K, Kawamoto H. Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation? World J Gastrointest Endosc 2024; 16(9): 519-525 [PMID: 39351176 DOI: 10.4253/wjge.v16.i9.519]
Corresponding Author of This Article
Tomohiro Tanikawa, PhD, Assistant Professor, Doctor, Department of General Internal Medicine 2, Kawasaki Medical School, 2-6-1, Nakasange, Kita-ku, Okayama 7008505, Japan. t-tanikawa@med.kawasaki-m.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/
Tomohiro Tanikawa, Keisuke Miyake, Mayuko Kawada, Katsunori Ishii, Takashi Fushimi, Noriyo Urata, Nozomu Wada, Ken Nishino, Mitsuhiko Suehiro, Miwa Kawanaka, Hidenori Shiraha, Ken Haruma, Hirofumi Kawamoto, Department of General Internal Medicine 2, Kawasaki Medical School, Okayama 7008505, Japan
Author contributions: Tanikawa T and Kawamoto H designed the study; Miyake K, Kawada M, and Ishii K performed the study; Urata N, Kawanaka M, and Tanikawa T analyzed the data; Tanikawa T, Nishino K, and Suehiro M drafted the manuscript; Fushimi T, Wada N, and Shiraha H critically revised the manuscript for important intellectual content; Kawamoto H and Haruma K supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Kawasaki Medical School.
Informed consent statement: This research study is a retrospective study that does not discuss individual patients.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomohiro Tanikawa, PhD, Assistant Professor, Doctor, Department of General Internal Medicine 2, Kawasaki Medical School, 2-6-1, Nakasange, Kita-ku, Okayama 7008505, Japan. t-tanikawa@med.kawasaki-m.ac.jp
Received: July 1, 2024 Revised: August 1, 2024 Accepted: August 12, 2024 Published online: September 16, 2024 Processing time: 72 Days and 23.9 Hours
Abstract
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a variety of adverse events (AEs). One of the most important AEs is post-ERCP pancreatitis (PEP), which is most common in cases of difficult biliary cannulation. Although the precut technique has been reported as a PEP risk factor, recent studies indicate that early precut could reduce PEP, and that precut itself is not a risk factor.
AIM
To evaluate the safety of the precut technique, especially in terms of PEP.
METHODS
We conducted a retrospective study, spanning the period from November 2011 through December 2021. It included 1556 patients, aged ≥ 20 years, who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center. We compared the PEP risk between the early precut and the delayed precut group.
RESULTS
The PEP incidence rate did not significantly differ between the precut and non-precut groups. However, the PEP incidence was significantly lower in the early precut group than the delayed precut group (3.5% vs 10.5%; P = 0.02). The PEP incidence in the delayed precut group without pancreatic stent insertion (17.3%) was significantly higher compared to other cases (P < 0.01).
CONCLUSION
Our findings indicate that early precut may reduce PEP incidence. If the precut decision is delayed, a pancreatic stent should be inserted to prevent PEP.
Core Tip: Early needle-knife precut papillotomy (NKPP) may significantly reduce the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with difficult bile duct cannulation. Our single-center retrospective study found that early NKPP (EP) within 10 min of standard cannulation attempts led to a lower PEP rate compared to delayed NKPP (DP). When EP is not feasible, inserting a pancreatic stent after DP effectively prevents PEP, demonstrating a similar protective effect as EP. These findings suggest adopting EP or pancreatic stenting for delayed procedures to improve patient outcomes.
