Pancreatitis Following Biliary Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones in Japan: A Multicenter Prospective Cohort Study.

OBJECTIVES

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is an adverse event of ERCP-related procedures. The present study aimed to evaluate the incidence of PEP in patients with an intact papilla who underwent ERCP for common bile duct stones and identify risk factors and preventive measures for PEP.

METHODS

Between April 2017 and March 2018, ERCP-related procedures were performed in 16,032 patients with an intact papilla at 36 institutions affiliated with the Bilio-pancreatic Study Group of West Japan. Of these, 3739 were prospectively enrolled to investigate adverse events of ERCP-related procedures targeting the biliary tract; the present study included 2106 patients with common bile duct stones.

RESULTS

PEP occurred in 132 patients (6.3%), and its severity was graded as mild (n = 104), moderate (n = 17), and severe (n = 11). Multivariable analysis identified the followin significant risk factors for PEP: age <50 years, female sex, wire-guided biliary cannulation, pancreatic guidewire-assisted biliary cannulation, biliary cannulation attempt duration ≥10 min, and total procedure time ≥60 min. Only pancreatic stenting was a preventive factor for PEP.

CONCLUSIONS

To prevent PEP, it is necessary to avoid guidewire insertion into the pancreatic duct, prolonged biliary cannulation attempts, and long ERCP procedure time, regardless of biliary cannulation with or without guidewire assistance. When a guidewire is inserted into the pancreatic duct in patients at high risk of PEP, pancreatic stenting should be considered.