title: Evaluation of guide wire cannulation technique in elderly patients with choledocholithiasis.
abstract: OBJECTIVE
  Post-ERCP pancreatitis is the most frequent complication of ERCP. We aimed to evaluate guide-wire cannulation as compared to conventional contrast-assisted cannulation with regard to the rate of post-ERCP pancreatitis (PEP) in elderly patients with choledocholithiasis.
  
  
  METHODS
  Patients aged 80 years or over with known choledocholithiasis, who were referred to ERCP in one single district hospital from January 2005 to March 2008 were reviewed retrospectively.
  
  
  RESULTS
  During this period, 246 ERCPs were performed in 217 patients. In 82 procedures (37.0%) deep cannulation of the biliary tree was achieved by means of a contrast-assisted procedure, whereas in the remaining 135 attempts a guide wire was used. Among the 64 patients older than 80 years, cannulation was accomplished in 25 by contrast visualization of the biliary tree and in 39 by means of the guide-wire. In the overall population of 217 patients, PEP occurred in 11 patients (5%), 10 and 1 case, respectively, for each of the two procedures (p = 0.00042). In the elderly patients, PEP occurred in 5 out of 25 patients after contrast filling of the bile duct, and in 1 out of 39 patients after the guide-wire utilization (p = 0.021). Cannulation was successful in 201 of 217 patients (92.6%), and in 57 of the 64 elderly patients (89%) (36 with guide wire, p = 0.42). Bleeding occurred in 5 patients (2.3%) and perforation in one (0.46%).
  
  
  CONCLUSIONS
  The guide-wire seems to reduce the incidence of pancreatitis in the elderly compared to conventional contrast but does not improve the success rate for cannulation.
authors: Endoscopy Unit, Democritus University of Thrace, Alexandroupolis, Greece.
authors: George
authors: G
authors: Kouklakis
authors: Anthia
authors: A
authors: Gatopoulou
authors: Nikolaos
authors: N
authors: Lirantzopoulos
authors: Eleni
authors: E
authors: Efraimidou
authors: Konstantinos
authors: K
authors: Manolas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010195:Pancreatitis / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media