Clinical Endoscopy

Synergistic effect of independent risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis: a multicenter retrospective study in Japan: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shunpei Hashigo, Shuji Tada; Clin Endosc 2024;57(4):508-514. Published online April 18, 2024; DOI: https://doi.org/10.5946/ce.2023.203

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Background
/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
Methods
This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP.
Results
PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033).
Conclusions
As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

Citations

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Optimal timing for discontinuation of ERCP in cases of difficult selective biliary cannulation
Han Taek Jeong, Jimin Han
Endoscopy International Open.2025;[Epub] CrossRef
Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
BMC Gastroenterology.2025;[Epub] CrossRef
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I.М. Mamontov, D.D. Rjabushhenko, Т.І. Tamm, К.О. Kramarenko, V.V. Nepomniashchyi, A.T. Ustinov
Український радіологічний та онкологічний журнал.2024; 32(3): 287. CrossRef

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Side-viewing scope insertion using a large-diameter overtube designed for colonoscopy in a patient with a cascade stomach: Hirokazu Saito, Yoshitaka Kadowaki, Atsushi Fujimoto, Kana Ohmoto, Shuji Tada; Clin Endosc 2023;56(2):256-257. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.089

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Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada; Clin Endosc 2022;55(2):263-269. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.153

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Background
/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.
Methods
This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.
Results
Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.
Conclusions
Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

Citations

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Taira Kuroda, Hideki Miyata, Kozue Kanemitsu-Okada, Emi Yanagihara, Hironobu Saneto, Taisei Murakami, Hirofumi Izumoto, Kei Onishi, Shogo Kitahata, Tomoe Kawamura, Ryuichiro Iwasaki, Fujimasa Tada, Eiji Tsubouchi, Atsushi Hiraoka, Tomoyuki Ninomiya
Digestive Diseases and Sciences.2025; 70(2): 843. CrossRef
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DEN Open.2025;[Epub] CrossRef
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Journal of Clinical Personalized Medicine.2024; 03(01): 100. CrossRef
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Edina Tari, Endre Botond Gagyi, Anett Rancz, Dániel Sándor Veres, Szilárd Váncsa, Péter Jenő Hegyi, Krisztina Hagymási, Péter Hegyi, Bálint Erőss
Scientific Reports.2024;[Epub] CrossRef
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Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
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The Korean Journal of Gastroenterology.2024; 84(3): 111. CrossRef
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