Comparable safety of ERCP in symptomatic and asymptomatic patients with common bile duct stones: a propensity-matched analysis

Xiao, Lina; Geng, Chong; Li, Xiao; Li, Yanni; Wang, Chunhui

doi:10.1080/00365521.2020.1853222

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…In summary, our previous report found the risk of PEP to be higher in the asymptomatic group than in the symptomatic group: 14.6% (28/164) vs 3.0% (28/949) ( P < 0.001) 7 . The rates of PEP in asymptomatic patients in the present study were similar to those in other recent studies (7.6–21%) 8–10,15 …”

Section: Discussionsupporting

confidence: 90%

Endoscopic retrograde cholangiopancreatography‐related complications for bile duct stones in asymptomatic and symptomatic patients

Saito

Kadono

Shono³

et al. 2021

JGH Open

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Background and Aim Current guidelines recommend the removal of common bile duct (CBD) stones by endoscopic retrograde cholangiopancreatography (ERCP) for both asymptomatic and symptomatic patients. We conducted this study because of the limited research comparing the risks of ERCP‐related complications between these two groups. Methods This retrospective study involved 1491 patients with native major duodenal papilla diagnosed with choledocholithiasis at three institutions in Japan. The rates of ERCP‐related complications, including post‐ERCP pancreatitis (PEP), cholangitis, bleeding, and perforation, were compared using one‐to‐one propensity score matching between the asymptomatic and symptomatic patients. Results Complications were observed in 112 (7.5%) of the 1491 patients (asymptomatic group: 31/172 [18.0%] vs symptomatic group: 81/1319 [6.1%], P < 0.001). The rate of severe complications was higher in the asymptomatic group than that in the symptomatic group (asymptomatic group: 5/31 [16.1%] vs symptomatic group: 3/81 [3.7%], P = 0.036). In the propensity‐matched asymptomatic and symptomatic patients, the incidences of PEP, cholangitis, bleeding, and perforation were 18/143 (12.6%) vs 4/143 (2.8%) (P = 0.003); 4/107 (3.7%) vs 6/107 (5.6%) (P = 0.75); 1/140 (0.7%) vs 3/140 (2.1%) (P = 0.62); and 2/140 (1.4%) vs 2/140 (1.4%) (P = 1.0). Conclusions ERCP for asymptomatic patients with CBD stones is associated with a higher risk of overall and severe complications than that for symptomatic patients with CBD stones; the overall rate is influenced by the high incidence of PEP in the asymptomatic group. Endoscopists should explain the risk of ERCP‐related complications for asymptomatic patients before performing the procedure.

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Section: Discussionsupporting

confidence: 90%

Endoscopic retrograde cholangiopancreatography‐related complications for bile duct stones in asymptomatic and symptomatic patients

Saito

Kadono

Shono³

et al. 2021

JGH Open

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“…Recently, several studies have revealed that asymptomatic CBDS was a risk factor for the incidence of PEP. 13,14,[23][24][25][26][27] The results obtained in the present study may explain why asymptomatic CBDS was associated with a high PEP risk. As such, experienced endoscopists may promote better outcomes in patients with asymptomatic CBDS.…”

Section: Discussionsupporting

confidence: 57%

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

Saito

Kadono²,

Shono

et al. 2022

Clin Endosc

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Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.Conclusions: Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

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“…Although a single-center retrospective study, in which ERCP was performed by skilled endoscopists, reported that the incidence of both overall ERCP-related complications and PEP in asymptomatic patients were comparable with those of symptomatic patients[ 13 ], other studies reported that the incidence rate of overall ERCP-related complication was approximately 15%-25% in asymptomatic patients and 4%-12% in symptomatic patients, and the incidence of PEP was approximately 12%-20% in asymptomatic patients and 2%-7% in symptomatic patients[ 9 - 12 ]. Therefore, the risk of ERCP-related complications, in particular the risk of PEP, in asymptomatic patients with CBDS is possibly higher than that of symptomatic patients.…”

Section: Risk Of Ercp-related Complications For Asymptomatic Cbdsmentioning

confidence: 99%

“…A previous study reported that precut sphincterotomy, biliary sphincter dilation, and involvement of trainees were significant risk factors for developing PEP in asymptomatic CBDS[ 50 ]. A propensity-score matched study reported that ERCP for asymptomatic CBDS conducted by experienced endoscopists was of comparable safety as ERCP for symptomatic CBDS[ 13 ]. ERCP for asymptomatic CBDS should therefore be performed by experienced endoscopists.…”

Section: Strategy Of Ercp For Asymptomaic Cbds To Reduce Ercp-related Complicationsmentioning

confidence: 99%

“…Some investigators recently reported the risk of ERCP-related complications focusing on asymptomatic CBDS. An overall incidence rate of ERCP-related complication for asymptomatic CBDS was reported to be approximately 15%-25%, with a PEP incidence of approximately 12%-20%[ 9 - 13 ]. The risk of ERCP-related complications, in particular the risk of PEP, for asymptomatic CBDS appeared to be higher than that previously reported.…”

Section: Introductionmentioning

confidence: 99%

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Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones

Saito¹,

Kadono²,

Shono³

et al. 2021

WJG

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Current guidelines for treating asymptomatic common bile duct stones (CBDS) recommend stone removal, with endoscopic retrograde cholangiopancreatography (ERCP) being the first treatment choice. When deciding on ERCP treatment for asymptomatic CBDS, the risk of ERCP-related complications and outcome of natural history of asymptomatic CBDS should be compared. The incidence rate of ERCP-related complications, particularly of post-ERCP pancreatitis for asymptomatic CBDS, was reportedly higher than that of symptomatic CBDS, increasing the risk of ERCP-related complications for asymptomatic CBDS compared with that previously reported for biliopancreatic diseases. Although studies have reported short- to middle-term outcomes of natural history of asymptomatic CBDS, its long-term natural history is not well known. Till date, there are no prospective studies that determined whether ERCP has a better outcome than no treatment in patients with asymptomatic CBDS or not. No randomized controlled trial has evaluated the risk of early and late ERCP-related complications vs the risk of biliary complications in the wait-and-see approach, suggesting that a change is needed in our perspective on endoscopic treatment for asymptomatic CBDS. Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to discuss whether routine endoscopic treatment for asymptomatic CBDS is justified or not.

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Comparable safety of ERCP in symptomatic and asymptomatic patients with common bile duct stones: a propensity-matched analysis

Cited by 12 publications

References 25 publications

Endoscopic retrograde cholangiopancreatography‐related complications for bile duct stones in asymptomatic and symptomatic patients

Endoscopic retrograde cholangiopancreatography‐related complications for bile duct stones in asymptomatic and symptomatic patients

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones

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