title: Perforation of the Papilla of Vater in Wire-Guided Cannulation.
abstract: Background. WGC in ERCP is considered a safe technique, although rare complications can occur. One unique complication of WGC is the perforation of the papilla of Vater by the guidewire. Subjects and Methods. Of 2032 patients who underwent ERCP at our department between January 2010 and December 2014, we selected 208 patients who underwent WGC for naïve papilla as subjects. A detailed examination of patients in whom a perforation occurred was conducted, and risk factors for perforations were investigated. Results. The perforation was observed in 7 of 208 patients (3.4%). All patients recovered with conservative treatment without the need for surgery. The perforation rate was significantly higher in the patients with juxtapapillary duodenal diverticula than those without diverticula (12.5% versus 0.6%, p < 0.001). Cannulation of the bile duct was ultimately achieved in 5 of 7 patients; PSP was performed for 4 of these patients. Conclusion. Caution must be exercised when dealing with patients who have a juxtapapillary duodenal diverticula because they are at higher risk of perforations. Because these are small perforations made by a wire, most of them heal with conservative treatment. However, perforations can make cannulation difficult, and PSP may be useful for deep cannulation.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan.
authors.forename: Yuichi
authors.identifier: 0000-0001-6803-9460
authors.initials: Y
authors.lastname: Takano
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan.
authors.forename: Masatsugu
authors.identifier: 0000-0002-7773-3072
authors.initials: M
authors.lastname: Nagahama
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan.
authors.forename: Eiichi
authors.identifier: 0000-0002-5446-7314
authors.initials: E
authors.lastname: Yamamura
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Maruoka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan.
authors.forename: Hiroshi
authors.identifier: 0000-0001-5957-8286
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000293:injuries* / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D003137:Common Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology*; D004240:Diverticulum / Q000150:complications; D004378:Duodenal Diseases / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies