title: Risk for post-ERCP pancreatitis after needle knife precut sphincterotomy following repeated cannulation attempts.
abstract: OBJECTIVE
  The aim of this study was to determine the risk and identify the factors associated with post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients who undergo needle knife precut sphincterotomy (NKS). In addition, we evaluated the effect of gabexate for the prevention of post-ERCP pancreatitis.
  
  
  BACKGROUND
  NKS, after repeated cannulation attempts during ERCP, is known to increase the risk of post-ERCP pancreatitis. However, the specific risk factors for post-ERCP pancreatitis have not been identified, and the preventive role of protease inhibitors, such as gabexate, has not yet been established.
  
  
  METHODS
  The medical records of 200 patients who underwent NKS, after repeated cannulation attempts during ERCP, were reviewed retrospectively. The potential risk factors for post-ERCP pancreatitis were investigated. The effect of gabexate infused after the ERCP procedure was also evaluated.
  
  
  RESULTS
  Thirteen (6.5%) patients out of 200 developed post-ERCP pancreatitis. Sex, age, the presence of pancreatitis at procedure, underlying disease, direction of the sphincterotomy, success or failure of cannulation after NKS, diameter of common bile duct, pancreatic duct status, and the presence of acinar filling were not associated with the risk of pancreatitis. Gabexate infusion after ERCP increased the incidence of ERCP-associated pancreatitis.
  
  
  CONCLUSIONS
  We could not identify any risk factors associated with the development of post-ERCP pancreatitis in patients who underwent NKS after repeated cannulation attempts during ERCP. However, gabexate administered after the ERCP procedure was found to increase the incidence of pancreatitis.
authors.affiliation: Department of Internal Medicine, Dongguk University International Hospital, Dongguk University College of Medicine, Goyang, Korea.
authors.forename: Jun Kyu
authors.initials: JK
authors.lastname: Lee
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Yoon
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Kwang Hyuck
authors.initials: KH
authors.lastname: Lee
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D005260:Female; D016670:Gabexate / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods
chemical_list: D015842:Serine Proteinase Inhibitors; D016670:Gabexate