Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?: A Meta-Analysis of Randomized Controlled Trials

Cennamo, Vincenzo; Fuccio, Lorenzo; Zagari, Rocco Maurizio; Eusebi, Leonardo Henry; Ceroni, Liza; Laterza, Liboria; Fabbri, Carlo; Bazzoli, Franco

doi:10.1038/ajg.2009.269

Cited by 150 publications

(115 citation statements)

References 32 publications

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“…In a meta-analysis of five randomised controlled trials (RCTs), guidewire cannulation was shown to lower post-ERCP pancreatitis (rates 0%-3%) compared to standard contrast-injection method (rates 4%-12%) and increase primary cannulation rates compared to the standard method (OR = 2.05) [19] . A Cochrane meta-analysis of 12 RCTs (3450 patients) similarly found that post-ERCP pancreatitis incidence was lower in the wire-guided cannulation (WGC) group (3.5%) compared to contrast-assisted cannulation technique (6.7%) and primary cannulation rates were higher in the WCG group (84% vs 77%, RR = 1.07).…”

Section: Ercp Techniquementioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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Section: Ercp Techniquementioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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“…29 Systemic analyses suggest that WGC is more successful and associated with less PEP when compared to catheter and contrast injection. [68][69][70][71] The risk of PEP is similar for both cannulation techniques when pancreatic stenting is allowed, however the protective effect of WGC is negated when trainees are involved. 70 There are two methods of WGC.…”

Section: Procedures Techniquesmentioning

confidence: 97%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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“…Most trials and meta-analyses suggest that WGC lowers rates of post-ERCP pancreatitis compared with the classic cannulate and inject method, which is largely historical ( 11 ). However, during GWC intended for the bile duct, inadvertent passage of a wire in the PD is relatively common, though oft en dismissed as inconsequential.…”

Section: Editorialmentioning

confidence: 99%