Post‐endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

Saito, Hirokazu; Koga, Takehiko; Sakaguchi, Masafumi; Kadono, Yoshihiro; Kamikawa, Kentaro; Urata, Atsushi; Imamura, Haruo; Tada, Shuji; Kakuma, Tatsuyuki; Matsushita, Ikuo

doi:10.1111/jgh.14604

Cited by 31 publications

(46 citation statements)

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“…We used standardized mean difference (SMD), which is not influenced by sample size, to check the balance of matched samples between single‐ and two‐stage stone removal groups. Propensity‐matched samples with SMD <0.10 is desirable . In this study, SMD in almost all factors shown in Tables and was <0.10, and SMD in only a factor of pancreatic injection was 0.105.…”

Section: Methodsmentioning

confidence: 59%

Post‐endoscopic retrograde cholangiopancreatography pancreatitis in single‐stage endoscopic common bile duct stone removal

et al. 2019

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Background and Aims Papillary treatment, such as endoscopic sphincterotomy or endoscopic papillary balloon dilation, and subsequent single‐stage endoscopic stone removal are often performed for choledocholithiasis; however, the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is unclear. This study aimed to compare the overall incidence of PEP between single‐ and two‐stage stone removal groups and the incidence of PEP between these two groups based on cannulation time. Methods We included 897 patients with native papilla who underwent papillary treatment and stone removal for choledocholithiasis with no inflammation or mild‐to‐moderate acute cholangitis at three institutions between April 2012 and March 2018 in Japan. We performed a propensity‐matched analysis and regression adjustment by propensity score to adjust for potential confounding factors. Results In the propensity‐matched analysis with 234 pairs, there was no significant difference in the overall incidence of PEP between single‐ and two‐stage stone removal procedures (15/234, 6.4% vs 6/234, 2.6%, P = 0.072, respectively). Although single‐stage stone removal after a cannulation time of ≤15 min was not a significant risk factor of PEP, the procedure after a cannulation time of >15 min was a significant risk factor of PEP as estimated by regression adjustment by propensity score (P = 0.014, 95% CI = 1.4–19.4, odds ratio = 5.2). Conclusions Single‐stage endoscopic stone removal after a long cannulation time of >15 min increased the incidence of PEP compared with the two‐stage stone removal procedure. Thus, single‐stage stone removal should be performed in patients with a cannulation time ≤ 15 min.

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Section: Methodsmentioning

confidence: 59%

Post‐endoscopic retrograde cholangiopancreatography pancreatitis in single‐stage endoscopic common bile duct stone removal

et al. 2019

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“…In our previous study, we performed a propensity-matched analysis including 949 symptomatic CBD patients and 164 asymptomatic CBD patients and revealed that the incidence of PEP was significantly higher in patients with asymptomatic CBD stones than in those with symptomatic CBD stones [24/164 (14.6%) vs 28/949 (3.0%), P < 0.001, odds ratio: 5.6]. In another propensity-matched analysis of 158 matched pairs, a similar result was obtained [24/158 (15.2%) vs 5/158 (3.2%), respectively, P < 0.001, odds ratio: 5.5][7]. These findings were corroborated by those of other retrospective studies[8,9].…”

Section: Introductionmentioning

confidence: 59%

“…Meanwhile, the risk of procedure-related complications, particularly PEP, should be considered when performing ERCP in patients with asymptomatic CBD stones. The overall incidence rate of ERCP for asymptomatic CBD stone was approximately 20% and the incidence rate of PEP was reportedly between 12.5% and 14.6%[7,8]. This high incidence rate of PEP in patients with asymptomatic CBD stones may be attributed to the presence of multiple patient- and procedure-related risk factors, such as normal serum bilirubin levels, non-dilated CBD, and difficult biliary cannulation.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 168 enrolled patients, 164 and 4 underwent successful and unsuccessful cannulation, respectively. Those 164 patients in whom successful cannulation was performed were included in our previous study examining the incidence of PEP in patients with asymptomatic CBD stones[7]. We performed univariate and multivariate analyses to identify the risk factors for PEP development in patients with asymptomatic CBD stones.…”

Section: Methodsmentioning

confidence: 99%

“…However, ERCP for asymptomatic CBD stones is associated with a high risk of PEP development[7-9]. In our previous study, we performed a propensity-matched analysis including 949 symptomatic CBD patients and 164 asymptomatic CBD patients and revealed that the incidence of PEP was significantly higher in patients with asymptomatic CBD stones than in those with symptomatic CBD stones [24/164 (14.6%) vs 28/949 (3.0%), P < 0.001, odds ratio: 5.6].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

Saito¹,

Kakuma

Matsushita³

2019

WJGE

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BACKGROUNDPrevious studies have revealed that patients with asymptomatic common bile duct (CBD) stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIMTo examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODSUsing medical records of three institutions in Japan for 6 years, we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP. We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTSThe overall incidence rate of PEP in all the patients with during study period was 4.7% (53/1135). Of the 168 patients with asymptomatic CBD stones, 24 (14.3%) developed PEP. In univariate analysis, precut sphincterotomy (P = 0.009) and biliary balloon sphincter dilation (P = 0.043) were significant risk factors for PEP. In multivariate analysis, precut sphincterotomy (P = 0.002, 95%CI: 2.2-27.8, odds ratio = 7.7), biliary balloon sphincter dilation (P = 0.015, 95%CI: 1.4-17.3, odds ratio = 4.9), and trainee endoscopists (P = 0.048, 95%CI: 1.01-8.1, odds ratio = 2.9) were significant risk factors for PEP.CONCLUSIONERCP for asymptomatic CBD stones should be performed by experienced endoscopists. When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones, the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.

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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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Post‐endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

Cited by 31 publications

References 30 publications

Post‐endoscopic retrograde cholangiopancreatography pancreatitis in single‐stage endoscopic common bile duct stone removal

Post‐endoscopic retrograde cholangiopancreatography pancreatitis in single‐stage endoscopic common bile duct stone removal

Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

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

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