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A RETROSPECTIVE COMPARISON OF ERCP COMPLICATIONS WITH CONVENTIONAL ERCP VS WIRE GUIDED ERCP
G Ward, L Keyvani, DR Duerksen
University of Manitoba, Winnipeg, Manitoba
Endoscopic Retrograde Cholangiopancreatography (ERCP) is an invasive endoscopic technique which affords both diagnostic studies and therapeutic interventions. This procedure is associated with potentially severe complications including post ERCP pancreatitis. One of the factors that may increase the risk of post ERCP pancreatitis is contrast opacification of the pancreatic duct. Recently, a wire guided technique has been developed which avoids opacification of the pancreatic duct. The purpose of this study was to determine whether there was any difference in post ERCP pancreatitis requiring hospitalization when conventional cannulation using contrast is compared with wire guided cannulation.
A retrospective review of ERCP at a single institution was performed. In 2005 there was a change made from a conventional contrast injection approach to use of a wire guided approach to ERCP. This latter technique involves cannulating the common bile duct with a guide wire prior to injecting contrast. If the pancreatic duct is cannulated, no contrast is injected into the ductal system. A retrospective chart review of ERCPs performed in April through September 2004 and January through June 2005 was performed. Data on procedure length, indication, and complications including pancreatitis was gathered. Pancreatitis was defined as pain post procedure associated with an increased lipase and requiring a hospital stay.
A total of 282 ERCPs were performed within the study period by 3 endoscopists, with 14 episodes of post-ERCP pancreatitis (5.0%) documented. The mean age of the patients was 63 years with 42% being male. A therapeutic intervention was performed in 77% of cases. There were no differences in demographics between groups. In the 2005 period, 130 ERCPs were performed, with 3 cases of pancreatitis, compared with 152 ERCPs in 2004, with 11 cases of pancreatitis [Odds Ratio 0.30 (0.08 to 1.11)]. During the study period, 167 ERCPs were performed using the wire guided technique, with 4 cases of pancreatitis, compared with 115 ERCPs performed conventionally, with 10 cases of pancreatitis [Odds Ratio 0.26 (0.09 to 0.79)]. Procedure length was not significantly different.
This retrospective study demonstrates that wire guided ERCP is associated with a lower rate of post-ERCP pancreatitis than conventional ERCP.
Some research funding has been provided to Dr Duerksen by Boston Scientific