Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis

Tse, Frances; Liu, Jasmine; Yuan, Yuhong; Martin, Paul; Leontiadis, Grigorios I

doi:10.1002/14651858.cd009662.pub3

Cited by 13 publications

(8 citation statements)

References 111 publications

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“…Providing clarity, in a recent systematic review involving 15 trials, avoiding cannulation with radiocontrast agents decreased the risk of AP in most trials. The use of guidewire cannulation compared with contrast-guided cannulation also seems to decrease the risk of severe AP and other complications, including bleeding and perforation (139).…”

Section: Preventing Post-ercp Pancreatitismentioning

confidence: 99%

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

Tenner,

Vege,

Sheth

et al. 2023

Am J Gastroenterol

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Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.

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Section: Preventing Post-ercp Pancreatitismentioning

confidence: 99%

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

Tenner,

Vege,

Sheth

et al. 2023

Am J Gastroenterol

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“…In addition, the guidewire-assisted cannulation technique may result in an increase in primary cannulation success (RR, 1.06; 95% CI, 1.01–1.12). 31 …”

Section: Post-ercp Pancreatitismentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

Lim

Khor

2023

Clin Endosc

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Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

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“…Endoscopic retrograde cholangiography (ERCP) is a useful and the preferred therapeutic endoscopic procedure for several biliary pathologies. Failure rates for cannulation of the main bile duct are described in the range of 18-20% [ 1 ], and in the hands of experienced endoscopists this can be reduced to 5-15% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Association between type of major duodenal papilla and difficult biliary cannulation at first endoscopic retrograde cholangiopancreatography in adults: a cross-sectional study with bootstrap method

Estela¹

2023

aog

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Background The type of major duodenal papilla could be associated with difficult biliary cannulation at first endoscopic retrograde cholangiopancreatography (ERCP) in adults. Methods This retrospective cross-sectional study included patients undergoing ERCP for the first time by an expert endoscopist. We defined the type of papilla according to the endoscopic classification of Haraldsson in type 1-4. The outcome of interest was difficult biliary cannulation, defined according to the European Society of Gastroenterology. To assess the association of interest, we calculated crude and adjusted prevalence ratios (PRc and PRa, respectively) and their respective 95% confidence intervals (CI) using Poisson regression with robust variance models, employing bootstrap methods. For the adjusted model we included the variables age, sex, and indication for ERCP, according to an epidemiological approach. Results We included 230 patients. The most frequent type of papilla was type 1 (43.5%), and 101 (43.9%) of the patients presented difficult biliary cannulation. The results were consistent between the crude and adjusted analyses. After adjusting for age, sex, and ERCP indication, the prevalence of difficult biliary cannulation was highest in patients with papilla type 3 (PRa 3.66, 95%CI 2.49-5.84), followed by patients with papilla type 4 (PRa 3.21, 95%CI 1.82-5.75), and patients with papilla type 2 (PRa 1.95, 95%CI 1.15-3.20) compared to patients with papilla type 1. Conclusion In adults undergoing ERCP for the first time, patients with papilla type 3 had a greater prevalence of difficult biliary cannulation than patients with papilla type 1.

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Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis

Cited by 13 publications

References 111 publications

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

Association between type of major duodenal papilla and difficult biliary cannulation at first endoscopic retrograde cholangiopancreatography in adults: a cross-sectional study with bootstrap method

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