Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
© 2024 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
Jimin Han is currently serving as a section editor of Clinical Endoscopy; however, she was not involved in the peer reviewer selection, evaluation, or decision process of this manuscript. The other authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: JH; Data curation: HTJ, JHB; Formal analysis: HTJ, JHB, HGK; Investigation: HTJ, HGK, JH; Methodology: JH, HGK; Supervision: JH; Writing–original draft: HTJ; Writing–review & editing: all authors.
Variable | Total (n=240) | SGT (n=163) | DGT (n=77) | p-value |
---|---|---|---|---|
Age (yr) | 71 (60–80) | 71 (60–80) | 71 (58–80) | 0.609 |
Male | 142 (59.2) | 93 (57.1) | 49 (63.6) | 0.399 |
Body mass index (kg/m2) | 23.6 (21.4–25.4) | 23.5 (21.4–25.6) | 23.8 (21.2–25.4) | 0.703 |
Comorbidity | ||||
Hypertension | 101 (42.1) | 70 (42.9) | 31 (40.3) | 0.780 |
Diabetes mellitus | 61 (25.4) | 44 (27.0) | 17 (22.1) | 0.433 |
Hyperlipidemia | 37 (15.4) | 24 (14.7) | 13 (16.9) | 0.703 |
Ischemic heart disease | 18 (7.5) | 12 (7.4) | 6 (7.8) | 1.000 |
Amylase (U/L) | 74 (47–141) | 64 (43–113) | 103 (68–290) | 0.016 |
Lipase (U/L) | 57 (33–143) | 45 (29–89) | 104 (53–640) | 0.017 |
Amylase >3×UNL | 31 (12.9) | 13 (8.0) | 18 (23.4) | 0.001 |
Post-ERCP pancreatitis | 14 (5.8) | 7 (4.3) | 7 (9.1) | 0.150 |
Mild | 13 (92.9) | 6 (85.7) | 7 (100.0) | |
Moderate | 1 (7.1) | 1 (14.3) | 0 (0) | |
Severe | 0 (0) | 0 (0) | 0 (0) | |
Etiology | 0.009 | |||
Stone | 143 (59.6) | 108 (66.3) | 35 (45.5) | |
Malignant | 60 (25.0) | 33 (20.2) | 27 (35.1) | |
Benign stricture | 12 (5.0) | 9 (5.5) | 3 (3.9) | |
Othersa) | 25 (10.4) | 13 (8.0) | 12 (15.6) | |
Surgically altered anatomy | 16 (6.7) | 13 (8.0) | 3 (3.9) | 0.282 |
Liver transplantation | 10 (4.2) | 8 (4.9) | 2 (2.6) | |
Billroth I | 3 (1.3) | 2 (1.2) | 1 (1.3) | |
Billroth II | 3 (1.3) | 3 (1.8) | 0 (0) | |
Periampullary diverticulum | 72 (30.0) | 56 (34.4) | 16 (20.8) | 0.035 |
Procedure time (sec) | 617 (421–958) | 541 (350–807) | 884 (653–1,142) | <0.001 |
CBD cannulation time >5 min | 85 (35.4) | 25 (15.3) | 60 (77.9) | <0.001 |
Success rate | 220 (91.7) | 156 (95.7) | 64 (83.1) | 0.002 |
Additional procedures | ||||
Infundibulotomy | 7 (2.9) | 4 (2.5) | 3 (3.9) | 0.683 |
Transpancreatic sphincterotomy | 28 (11.7) | 0 (0) | 28 (36.4) | <0.001 |
Prophylactic PD stent | 24 (10.0) | 0 (0) | 24 (31.2) | <0.001 |
Endoscopic sphincterotomy | 142 (59.2) | 97 (59.5) | 45 (58.4) | 0.889 |
Endoscopic papillary balloon dilatation | 25 (10.4) | 20 (12.3) | 5 (6.5) | 0.186 |
Values are presented as median (interquartile range) or number (%).
SGT, single-guidewire technique; DGT, double-guidewire technique; UNL, upper normal limit; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; PD, pancreatic duct.
a)Others included 8 clinical cholangitis, 5 intraductal papillary mucinous neoplasm, 4 choledochal cyst, 3 periampullary diverticulum, 2 common bile duct dilatation, 1 autoimmune pancreatitis, 1 post-cholecystectomy bile leakage, and 1 intraductal papillary neoplasm of the bile duct.
Variable | Total (n=240) | Without PEP (n=226) | With PEP (n=14) | p-value |
---|---|---|---|---|
Age (yr) | 71 (60–80) | 71 (61–80) | 69 (38–77) | <0.001 |
Male | 142 (59.2) | 137 (60.6) | 5 (35.7) | 0.092 |
Body mass index (kg/m2) | 23.6 (21.4–25.4) | 23.5 (21.3–25.5) | 24.5 (23.2–25.3) | 0.250 |
Comorbidity | ||||
Hypertension | 101 (42.1) | 95 (42.0) | 6 (42.9) | 1.000 |
Diabetes mellitus | 61 (25.4) | 54 (23.9) | 7 (50.0) | 0.051 |
Hyperlipidemia | 37 (15.4) | 31 (13.7) | 6 (42.9) | 0.011 |
Ischemic heart disease | 18 (7.5) | 16 (7.1) | 2 (14.3) | 0.283 |
Amylase (U/L) | 74 (47–141) | 71 (45–120) | 1,308 (937–1,867) | <0.001 |
Lipase (U/L) | 57 (33–143) | 55 (33–117) | 2,763 (1,575–4,115) | <0.001 |
Amylase >3×UNL | 31 (12.9) | 17 (7.5) | 14 (100.0) | <0.001 |
Etiology | 0.455 | |||
Stone | 143 (59.6) | 136 (60.2) | 7 (50.0) | |
Malignant | 60 (25.0) | 56 (24.8) | 4 (28.6) | |
Benign stricture | 12 (5.0) | 12 (5.3) | 0 (0.0) | |
Othersa) | 25 (10.4) | 22 (9.7) | 3 (21.4) | |
Surgically altered anatomy | 16 (6.7) | 16 (7.1) | 0 (0.0) | 0.607 |
Periampullary diverticulum | 72 (30.0) | 71 (31.4) | 1 (7.1) | 0.070 |
Procedure time (sec) | 617 (421–958) | 617 (416–955) | 708 (488–1,613) | 0.163 |
CBD cannulation time (sec) | 190 (84–415) | 168 (77–403) | 390 (239–487) | 0.010 |
PD cannulation time (sec)b) | 121 (78–230) | 121 (73–234) | 133 (109–195) | 0.563 |
CBD cannulation time >5 min | 85 (35.4) | 76 (33.6) | 9 (64.3) | 0.039 |
Success rate | 220 (91.7) | 207 (91.6) | 13 (92.9) | 1.000 |
Additional procedures | ||||
Double-guidewire technique | 77 (32.1) | 70 (31.0) | 7 (50.0) | 0.150 |
Infundibulotomy | 7 (2.9) | 6 (2.7) | 1 (7.1) | 0.347 |
Transpancreatic sphincterotomy | 28 (11.7) | 26 (11.5) | 2 (14.3) | 1.000 |
Prophylactic PD stent | 24 (10.0) | 22 (9.7) | 2 (14.3) | 0.638 |
Endoscopic sphincterotomy | 142 (59.2) | 133 (58.8) | 9 (64.3) | 0.785 |
Endoscopic papillary balloon dilatation | 25 (10.4) | 24 (10.6) | 1 (7.1) | 1.000 |
Values are presented as median (interquartile range) or number (%).
PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; UNL, upper normal limit; CBD, common bile duct; PD, pancreatic duct.
a)Others included 8 clinical cholangitis, 5 intraductal papillary mucinous neoplasm, 4 choledochal cyst, 3 periampullary diverticulum, 2 common bile duct dilatation, 1 autoimmune pancreatitis, 1 post-cholecystectomy bile leakage, and 1 intraductal papillary neoplasm of the bile duct.
b)Pancreatic duct cannulation time was calculated only in double-guidewire technique.
Variable |
Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex | ||||
Malea) | ||||
Female | 2.771 (0.899–8.537) | 0.076 | 3.693 (1.054–12.942) | 0.041 |
Age <50 yr | ||||
≥50 yra) | ||||
<50 yr | 3.530 (1.025–12.165) | 0.046 | 8.676 (1.969–38.240) | 0.004 |
Double-guidewire technique | ||||
Noa) | ||||
Yes | 2.229 (0.753–6.595) | 0.148 | ||
Hyperlipidemia | ||||
Noa) | ||||
Yes | 4.718 (1.533–14.521) | 0.007 | 5.913 (1.635–21.392) | 0.007 |
Diabetes mellitus | ||||
Noa) | ||||
Yes | 3.185 (1.069–9.486) | 0.037 | ||
Periampullary diverticulum | ||||
Noa) | ||||
Yes | 0.168 (0.022–1.309) | 0.089 | ||
CBD cannulation time | ||||
≤5 mina) | ||||
>5 min | 3.553 (1.150–10.970) | 0.028 | 4.062 (1.208–13.658) | 0.023 |
Body mass index (kg/m2)b) | ||||
≤23.0a) | ||||
>23.0 | 2.910 (0.790–10.713) | 0.108 |
Variable |
Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex | ||||
Malea) | ||||
Female | 1.350 (0.280-6.520) | 0.709 | ||
Age <50 yr | ||||
≥50 yra) | ||||
<50 yr | 5.812 (1.096-30.822) | 0.039 | 9.305 (1.367-63.358) | 0.023 |
Ttranspancreatic sphincterotomy | ||||
Noa) | ||||
Yes | 0.677 (0.122-3.743) | 0.655 | ||
Prophylactic PD stent | ||||
Noa) | ||||
Yes | 0.873 (0.157-4.853) | 0.876 | ||
Hyperlipidemia | ||||
Noa) | ||||
Yes | 4.500 (0.873-23.194) | 0.072 | 7.384 (1.103-49.424) | 0.039 |
Diabetes mellitus | ||||
Noa) | ||||
Yes | 3.000 (0.601-14.970) | 0.180 | ||
CBD cannulation time | ||||
≤5 mina) | ||||
>5 min | 0.682 (0.120-3.870) | 0.666 | ||
PD cannulation time | ||||
≤2 mina) | ||||
>2 min | 2.500 (0.454-13.760) | 0.292 | ||
Body mass index (kg/m2)b) | ||||
≤23.0a) | ||||
>23.0 | 4.000 (0.457-35.045) | 0.211 |
Variable | Total (n=240) | SGT (n=163) | DGT (n=77) | p-value |
---|---|---|---|---|
Age (yr) | 71 (60–80) | 71 (60–80) | 71 (58–80) | 0.609 |
Male | 142 (59.2) | 93 (57.1) | 49 (63.6) | 0.399 |
Body mass index (kg/m2) | 23.6 (21.4–25.4) | 23.5 (21.4–25.6) | 23.8 (21.2–25.4) | 0.703 |
Comorbidity | ||||
Hypertension | 101 (42.1) | 70 (42.9) | 31 (40.3) | 0.780 |
Diabetes mellitus | 61 (25.4) | 44 (27.0) | 17 (22.1) | 0.433 |
Hyperlipidemia | 37 (15.4) | 24 (14.7) | 13 (16.9) | 0.703 |
Ischemic heart disease | 18 (7.5) | 12 (7.4) | 6 (7.8) | 1.000 |
Amylase (U/L) | 74 (47–141) | 64 (43–113) | 103 (68–290) | 0.016 |
Lipase (U/L) | 57 (33–143) | 45 (29–89) | 104 (53–640) | 0.017 |
Amylase >3×UNL | 31 (12.9) | 13 (8.0) | 18 (23.4) | 0.001 |
Post-ERCP pancreatitis | 14 (5.8) | 7 (4.3) | 7 (9.1) | 0.150 |
Mild | 13 (92.9) | 6 (85.7) | 7 (100.0) | |
Moderate | 1 (7.1) | 1 (14.3) | 0 (0) | |
Severe | 0 (0) | 0 (0) | 0 (0) | |
Etiology | 0.009 | |||
Stone | 143 (59.6) | 108 (66.3) | 35 (45.5) | |
Malignant | 60 (25.0) | 33 (20.2) | 27 (35.1) | |
Benign stricture | 12 (5.0) | 9 (5.5) | 3 (3.9) | |
Others |
25 (10.4) | 13 (8.0) | 12 (15.6) | |
Surgically altered anatomy | 16 (6.7) | 13 (8.0) | 3 (3.9) | 0.282 |
Liver transplantation | 10 (4.2) | 8 (4.9) | 2 (2.6) | |
Billroth I | 3 (1.3) | 2 (1.2) | 1 (1.3) | |
Billroth II | 3 (1.3) | 3 (1.8) | 0 (0) | |
Periampullary diverticulum | 72 (30.0) | 56 (34.4) | 16 (20.8) | 0.035 |
Procedure time (sec) | 617 (421–958) | 541 (350–807) | 884 (653–1,142) | <0.001 |
CBD cannulation time >5 min | 85 (35.4) | 25 (15.3) | 60 (77.9) | <0.001 |
Success rate | 220 (91.7) | 156 (95.7) | 64 (83.1) | 0.002 |
Additional procedures | ||||
Infundibulotomy | 7 (2.9) | 4 (2.5) | 3 (3.9) | 0.683 |
Transpancreatic sphincterotomy | 28 (11.7) | 0 (0) | 28 (36.4) | <0.001 |
Prophylactic PD stent | 24 (10.0) | 0 (0) | 24 (31.2) | <0.001 |
Endoscopic sphincterotomy | 142 (59.2) | 97 (59.5) | 45 (58.4) | 0.889 |
Endoscopic papillary balloon dilatation | 25 (10.4) | 20 (12.3) | 5 (6.5) | 0.186 |
Variable | Total (n=240) | Without PEP (n=226) | With PEP (n=14) | p-value |
---|---|---|---|---|
Age (yr) | 71 (60–80) | 71 (61–80) | 69 (38–77) | <0.001 |
Male | 142 (59.2) | 137 (60.6) | 5 (35.7) | 0.092 |
Body mass index (kg/m2) | 23.6 (21.4–25.4) | 23.5 (21.3–25.5) | 24.5 (23.2–25.3) | 0.250 |
Comorbidity | ||||
Hypertension | 101 (42.1) | 95 (42.0) | 6 (42.9) | 1.000 |
Diabetes mellitus | 61 (25.4) | 54 (23.9) | 7 (50.0) | 0.051 |
Hyperlipidemia | 37 (15.4) | 31 (13.7) | 6 (42.9) | 0.011 |
Ischemic heart disease | 18 (7.5) | 16 (7.1) | 2 (14.3) | 0.283 |
Amylase (U/L) | 74 (47–141) | 71 (45–120) | 1,308 (937–1,867) | <0.001 |
Lipase (U/L) | 57 (33–143) | 55 (33–117) | 2,763 (1,575–4,115) | <0.001 |
Amylase >3×UNL | 31 (12.9) | 17 (7.5) | 14 (100.0) | <0.001 |
Etiology | 0.455 | |||
Stone | 143 (59.6) | 136 (60.2) | 7 (50.0) | |
Malignant | 60 (25.0) | 56 (24.8) | 4 (28.6) | |
Benign stricture | 12 (5.0) | 12 (5.3) | 0 (0.0) | |
Others |
25 (10.4) | 22 (9.7) | 3 (21.4) | |
Surgically altered anatomy | 16 (6.7) | 16 (7.1) | 0 (0.0) | 0.607 |
Periampullary diverticulum | 72 (30.0) | 71 (31.4) | 1 (7.1) | 0.070 |
Procedure time (sec) | 617 (421–958) | 617 (416–955) | 708 (488–1,613) | 0.163 |
CBD cannulation time (sec) | 190 (84–415) | 168 (77–403) | 390 (239–487) | 0.010 |
PD cannulation time (sec) |
121 (78–230) | 121 (73–234) | 133 (109–195) | 0.563 |
CBD cannulation time >5 min | 85 (35.4) | 76 (33.6) | 9 (64.3) | 0.039 |
Success rate | 220 (91.7) | 207 (91.6) | 13 (92.9) | 1.000 |
Additional procedures | ||||
Double-guidewire technique | 77 (32.1) | 70 (31.0) | 7 (50.0) | 0.150 |
Infundibulotomy | 7 (2.9) | 6 (2.7) | 1 (7.1) | 0.347 |
Transpancreatic sphincterotomy | 28 (11.7) | 26 (11.5) | 2 (14.3) | 1.000 |
Prophylactic PD stent | 24 (10.0) | 22 (9.7) | 2 (14.3) | 0.638 |
Endoscopic sphincterotomy | 142 (59.2) | 133 (58.8) | 9 (64.3) | 0.785 |
Endoscopic papillary balloon dilatation | 25 (10.4) | 24 (10.6) | 1 (7.1) | 1.000 |
Variable | Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex | ||||
Male |
||||
Female | 2.771 (0.899–8.537) | 0.076 | 3.693 (1.054–12.942) | 0.041 |
Age <50 yr | ||||
≥50 yr |
||||
<50 yr | 3.530 (1.025–12.165) | 0.046 | 8.676 (1.969–38.240) | 0.004 |
Double-guidewire technique | ||||
No |
||||
Yes | 2.229 (0.753–6.595) | 0.148 | ||
Hyperlipidemia | ||||
No |
||||
Yes | 4.718 (1.533–14.521) | 0.007 | 5.913 (1.635–21.392) | 0.007 |
Diabetes mellitus | ||||
No |
||||
Yes | 3.185 (1.069–9.486) | 0.037 | ||
Periampullary diverticulum | ||||
No |
||||
Yes | 0.168 (0.022–1.309) | 0.089 | ||
CBD cannulation time | ||||
≤5 min |
||||
>5 min | 3.553 (1.150–10.970) | 0.028 | 4.062 (1.208–13.658) | 0.023 |
Body mass index (kg/m2) |
||||
≤23.0 |
||||
>23.0 | 2.910 (0.790–10.713) | 0.108 |
Variable | Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex | ||||
Male |
||||
Female | 1.350 (0.280-6.520) | 0.709 | ||
Age <50 yr | ||||
≥50 yr |
||||
<50 yr | 5.812 (1.096-30.822) | 0.039 | 9.305 (1.367-63.358) | 0.023 |
Ttranspancreatic sphincterotomy | ||||
No |
||||
Yes | 0.677 (0.122-3.743) | 0.655 | ||
Prophylactic PD stent | ||||
No |
||||
Yes | 0.873 (0.157-4.853) | 0.876 | ||
Hyperlipidemia | ||||
No |
||||
Yes | 4.500 (0.873-23.194) | 0.072 | 7.384 (1.103-49.424) | 0.039 |
Diabetes mellitus | ||||
No |
||||
Yes | 3.000 (0.601-14.970) | 0.180 | ||
CBD cannulation time | ||||
≤5 min |
||||
>5 min | 0.682 (0.120-3.870) | 0.666 | ||
PD cannulation time | ||||
≤2 min |
||||
>2 min | 2.500 (0.454-13.760) | 0.292 | ||
Body mass index (kg/m2) |
||||
≤23.0 |
||||
>23.0 | 4.000 (0.457-35.045) | 0.211 |
Values are presented as median (interquartile range) or number (%). SGT, single-guidewire technique; DGT, double-guidewire technique; UNL, upper normal limit; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; PD, pancreatic duct. Others included 8 clinical cholangitis, 5 intraductal papillary mucinous neoplasm, 4 choledochal cyst, 3 periampullary diverticulum, 2 common bile duct dilatation, 1 autoimmune pancreatitis, 1 post-cholecystectomy bile leakage, and 1 intraductal papillary neoplasm of the bile duct.
Values are presented as median (interquartile range) or number (%). PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; UNL, upper normal limit; CBD, common bile duct; PD, pancreatic duct. Others included 8 clinical cholangitis, 5 intraductal papillary mucinous neoplasm, 4 choledochal cyst, 3 periampullary diverticulum, 2 common bile duct dilatation, 1 autoimmune pancreatitis, 1 post-cholecystectomy bile leakage, and 1 intraductal papillary neoplasm of the bile duct. Pancreatic duct cannulation time was calculated only in double-guidewire technique.
ERCP, endoscopic retrograde cholangiopancreatography; OR, odds ratio; CI, confidence interval; CBD, common bile duct. Reference category. The cut-off value of BMI was determined as the value corresponding to overweight in the Asian-Pacific guidelines.
ERCP, endoscopic retrograde cholangiopancreatography; OR, odds ratio; CI, confidence interval; PD, pancreatic duct; CBD, common bile duct. Reference category. The cut-off value of BMI was determined as the value corresponding to overweight in the Asian-Pacific guidelines.