title: A comparison of 4-Fr with 5-Fr endoscopic nasopancreatic drainage catheters: A randomized, controlled trial.
abstract: OBJECTIVE
  Although endoscopic nasopancreatic drainage (ENPD) is useful for collecting samples for pancreatic juice cytology and for treating leakage of pancreatic juice and occlusive pancreatitis, placement of the ENPD catheter is associated with complications such as post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We investigated whether an ENPD catheter with a smaller diameter could reduce the incidence of complications.
  
  
  METHODS
  Patients requiring placement of an ENPD catheter (n = 254) were enrolled and randomly assigned to one of two catheter-size groups: the 4-Fr group or the 5-Fr group. The incidence of PEP, cholangitis, and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples were compared between groups. In addition, univariate and multivariate analyses were conducted on factors associated with PEP.
  
  
  RESULTS
  The incidence of PEP was significantly lower in the 4-Fr group compared with the 5-Fr group (4.1% vs 12.4%, respectively; P = 0.021). The rate of cholangitis and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples did not differ between groups. Multivariate analysis revealed that the risk of PEP was 3.7 times higher when using a 5-Fr catheter than when using a 4-Fr catheter (P = 0.019). In addition, the risk of PEP was 4.1 times higher in patients with an intraductal papillary mucinous neoplasm than in those without (P = 0.0049) and 4.6 times higher in patients aged <65 than in those aged ≥65 (P = 0.0033).
  
  
  CONCLUSIONS
  A 4-Fr catheter is as useful as a 5-Fr catheter and is associated with a significantly lower incidence of PEP.
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan. d111261@hiroshima-u.ac.jp.
authors: Teruo
authors: T
authors: Mouri
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Tamito
authors: T
authors: Sasaki
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Masahiro
authors: M
authors: Serikawa
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Takashi
authors: T
authors: Ishigaki
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Yasutaka
authors: Y
authors: Ishii
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Akinori
authors: A
authors: Shimizu
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Tomofumi
authors: T
authors: Tsuboi
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Keisuke
authors: K
authors: Kurihara
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Yumiko
authors: Y
authors: Tatsukawa
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Eisuke
authors: E
authors: Miyaki
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Ryota
authors: R
authors: Kawamura
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Ken
authors: K
authors: Tsushima
authors: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors: Kazuaki
authors: K
authors: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation*; D003581:Cytodiagnosis / Q000379:methods; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: endoscopic nasopancreatic drainage; pancreatic cancer; post-endoscopic retrograde cholangiopancreatography pancreatitis; risk factor