A simple way of avoiding post-ERCP pancreatitis.
BACKGROUND
Pancreatitis occurs in up to 30% of patients who undergo ERCP. This study tested the hypothesis that post-ERCP pancreatitis can be avoided by initially accessing the bile duct with a soft-tipped Teflon tracer 0.035-inch guidewire.


METHODS
A single endoscopist performed ERCP in 400 consecutive patients with pancreatobiliary disease who were randomized to two groups. In Group A (200 patients), the bile duct was first accessed by insertion of a soft-tipped Teflon tracer (diameter 0.035 inch) guidewire through a 6F, double channel sphincterotome, followed by cannulation, injection of contrast, and sphincterotomy. In Group B (200 patients), the bile duct was opacified by using traditional methods of cannulation.


RESULTS
No case of acute pancreatitis was detected in Group A, whereas, 8 cases were observed in Group B (6 mild, one moderate, one severe) (p < 0.01). In 9 patients in Group A vs. 39 in Group B (p < 0.001), the serum amylase rose to more than 5 times the upper normal limit during the 24 hours after the procedure. There was no procedure-related mortality.


CONCLUSIONS
Accessing the bile duct with a soft-tipped tracer guidewire prevents post-ERCP pancreatitis.
Lella
Fausto
F
Department of Gastroenterology and Gastrointestinal Endoscopy Unit, Policlinico San Marco, Zingonia, Italy.
Bagnolo
Francesco
F
Colombo
Elena
E
Bonassi
Umberto
U
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001652:Bile Ducts; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011138:Polytetrafluoroethylene; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects
D003287:Contrast Media; D011138:Polytetrafluoroethylene; D000681:Amylases