title: Female gender and post-ERCP pancreatitis: is the association caused by difficult cannulation?
abstract: OBJECTIVE
  Female gender is a well-known risk factor for the development of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, but the underlying mechanism for this increased risk has remained unknown. We hypothesize that cannulation difficulty might play a part in this association. The aim of the current study was to determine whether the female papilla is more difficult to cannulate than the male papilla.
  
  
  METHODS
  Prospective data collection with emphasis on cannulation was conducted in 364 consecutive biliary ERCP procedures performed by very experienced ERCP endoscopists through native papilla in a tertiary referral university hospital.
  
  
  RESULTS
  Although the cannulation times seemed to be longer and alternative cannulation techniques seemed to be needed more frequently for successful cannulation in female than male patients, no statistically significant differences (p = 0.061 and 0.054, respectively) in the cannulation process could be found between the genders.
  
  
  CONCLUSIONS
  The study was not able to confirm that the cannulation of the female papilla is more troublesome than the cannulation of the male papilla.
authors.affiliation: Department of Surgery, Turku University Hospital, Turku, Finland. hanna.vihervaara@tyks.fi
authors.forename: Hanna
authors.initials: H
authors.lastname: Vihervaara
authors.forename: Paulina
authors.initials: P
authors.lastname: Salminen
authors.forename: Saija
authors.initials: S
authors.lastname: Hurme
authors.forename: Risto
authors.initials: R
authors.lastname: Gullichsen
authors.forename: Simo
authors.initials: S
authors.lastname: Laine
authors.forename: Juha M
authors.initials: JM
authors.lastname: Grönroos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D055815:Young Adult