Acute distal common bile duct angle is risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis in beginner endoscopist

Table 1 Baseline characteristics in both groups, n (%)

	Before propensity matching				After propensity matching
	Beginner (n = 97)	Expert (n = 196)	P value	D	Beginner (n = 69)	Expert (n = 69)	P value	D
Female	35 (36.1)	104 (53.1)	0.006	0.383	18 (26.1)	10 (14.5)	0.090	0.404
Age	69.8 ± 12.2	67.6± 12.3	0.143	0.179	71.8 ± 11.0	72.2 ± 10.7	0.790	0.037
Angle	29.5 ± 15.5	30.1 ± 16.1	0.752	0.038	29.6 ± 15.9	30.3 ± 16.4	0.789	0.043
Angle > 30 (%)	45 (46.4)	96 (49.0)	0.678	0.057	32 (46.4)	33 (47.8)	0.865	0.032
Bile duct dilatation	9.0 ± 3.3	8.2 ± 3.4	0.046	0.238	9.4 ± 3.3	10.0 ± 4.0	0.322	0.164
Benign Dz	78 (80.4)	132 (67.3)	0.019	0.380	63 (91.3)	64 (92.8)	0.753	0.109
Peripheral arterial disease	30 (30.9)	67 (34.2)	0.579	0.082	24 (34.8)	32 (46.4)	0.165	0.267
Erythema	10 (10.3)	26 (13.3)	0.470	0.158	8 (11.6)	11 (15.9)	0.459	0.203
Bulging	5 (5.2)	12 (6.1)	0.740	0.101	2 (2.9)	7 (10.1)	0.085	0.733

Table 2 Result of endoscopic retrograde cholangiopancreatography between acute or obtuse angle in both group, n (%)

	Beginner endoscopist				Expert endoscopist
	Total (n = 69)	Acute angle (n = 37)	Obtuse angle (n = 32)	P value	Total (n = 69)	Acute angle (n = 36)	Obtuse angle (n = 33)	P value
Success rate	67 (97.1)	35 (94.6)	32 (100)	0.187	68 (98.6)	36 (100)	32 (97)	0.293
Cannulation time	5.5 ± 6.0	6.7 ± 7.2	4.1 ± 4.2	0.076	4.3 ± 2.9	4.2 ± 2.9	4.3 ± 2.9	0.833
Total procedure	19.6 ± 10.3	20.7 ± 11.2	18.3 ± 9.2	0.330	17.7 ± 7.5	16.8 ± 4.4	18.8 ± 9.9	0.296
P-duct insertion or injection	22 (31.9)	14 (37.8)	8 (25.0)	0.260	10 (17.4)	6 (22.2)	4 (12.1)	0.276
P-duct stent	19 (27.5)	12 (32.4)	7 (21.9)	0.335	7 (10.1)	4 (11.1)	3 (9.1)	0.785
PEP	9 (13.0)	8 (21.6)	1 (3.1)	0.023a	3 (4.3)	1 (2.8)	2 (6.1)	0.511
Hyperamylase-mia	12 (17.4)	6 (16.2)	6 (18.8)	0.786	12 (17.4)	6 (16.7)	6 (18.2)	0.868
Bleeding	2 (2.9)	1 (2.7)	1 (3.1)	0.918	1 (1.4)	0 (0)	1 (3.0)	0.293
Perforation	0 (0)	0 (0)	0 (0)	N/A	0 (0)	0 (0)	0 (0)	N/A

^aP < 0.05. PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 3 Clinical factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis in beginner group, n (%)

	Beginner endoscopist
	Total (n = 69)	With PEP (n = 9)	Without PEP (n = 60)	P value
				Univariable	Multivari-able
Age (yr)	71.8 ± 11.0	73.0 ± 6.5	71.6 ± 11.5	0.718	-
Female	18 (26.1)	4 (44.4)	14 (23.3)	0.184	0.182
Periampullary diverticulum	24 (34.8)	3 (33.3)	21 (35.0)	0.923	-
Erythema	8 (11.6)	1 (1.1)	7 (11.7)	0.865	-
Buldging	2 (2.9)	0 (0.0)	2 (3.3)	0.585	-
Malignancy	6 (8.7)	0 (0)	6 (10.0)	0.328	-
Benign diseases	63 (91.3)	9 (100)	54 (90.0)	-	-
Bile duct dilatation	9.4 ± 3.3	9.4 ± 4.4	9.4 ± 3.2	0.937	-
Acute angle	37 (53.6)	8 (88.9)	29 (48.3)	0.023a	0.049a
Cannulation time (min)	5.5 ± 6.0	6.8 ± 2.1	5.3 ± 6.4	0.534	-
Total Procedure time (min)	19.6 ± 10.3	17.3 ± 4.9	19.9 ± 10.9	0.492	-
P-duct insertion or injection	22 (31.9)	5 (55.6)	17 (28.3)	0.105	0.181
P-duct stent	19 (27.5)	3 (33.3)	16 (26.7)	0.682	-

^aP < 0.05. PEP: post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 4 Clinical factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis in all patients, n (%)

	Total (n = 138)	With PEP (n = 12)	Without PEP (n = 126)	P value
				Univariable	Multivariable
Age (yr)	72.0 ± 10.8	72.1 ± 7.0	72.0 ± 11.1	0.978	-
Female	28 (20.3)	5 (41.7)	23 (18.3)	0.055	0.017a
Periampullary diverticulum	56 (40.6)	3 (25.0)	53 (42.1)	0.253	-
Erythema	19 (13.8)	2 (16.7)	17 (13.5)	0.762	-
Buldging	9 (6.5)	0 (0.0)	9 (7.1)	0.342	-
Malignancy	11 (8.7)	0 (0)	11 (8.7)	0.289	-
Benign diseases	127 (92.0)	12 (100)	115 (91.3)	-	-
Bile duct dilatation	9.7 ± 3.7	9.8 ± 3.9	9.7 ± 3.7	0.941	-
Acute angle	73 (52.9)	9 (75.0)	64 (50.8)	0.110	0.324
Beginner endoscopist	69 (50.0)	9 (75.0)	60 (47.6)	0.071	0.743
Cannulation time (min)	5.0 ± 4.7	6.7 ± 2.2	4.8 ± 4.9	0.201	0.052
Total Procedure time (min)	18.7 ± 9.1	16.8 ± 4.9	18.8 ± 9.4	0.467	-
P-duct insertion or injection	32 (23.2)	7 (58.3)	25 (19.8)	0.002a	0.003a
P-duct stent	27 (19.6)	3 (25.0)	24 (19.0)	0.622	-

^aP < 0.05.