1Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
2Department of Gastroenterology, Tsuruta Hospital, Kumamoto, Japan
3Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
4Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
5Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
6Department of Biostatics Center, Medical School, Kurume University, Fukuoka, Japan
Copyright © 2022 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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest: The authors have no potential conflicts of interest.
Funding: None.
Author Contributions
Conceptualization: Hirokazu Saito
Data curation: HS, Yoshihiro Kadono, Tatsuyuki Kakuma
Formal analysis: HS, TK
Investigation: HS, YK, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Shuji Tada
Methodology: HS, YK, TS, KK, AU, JN, HI, IM, TK, ST
Project administration: HS, ST
Resources: HS, YK, TS, KK, AU, JN, HI, IM, ST
Software: HS, TK
Supervision: ST
Validation: HS, TK, ST
Visualization: HS, ST
Writing-original draft: HS
Writing-review & editing: YK, TS, KK, AU, JN, HI, IM, TK, ST
CBD, common bile duct; EPBD, endoscopic papillary balloon dilation; EPLBD, endoscopic papillary large balloon dilation; ERCP, endoscopic retrograde cholangiopancreatography; EST, endoscopic sphincterotomy; NSAIDs, nonsteroidal anti-inflammatory drugs; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; PGW, pancreatic guidewire; SD, standard deviation.
All patients |
Propensity score-matched patients |
|||||
---|---|---|---|---|---|---|
With difficult cannulation (n=600) | Without difficult cannulation (n=806) | p-value | With difficult cannulation (n=221) | Without difficult cannulation (n=221) | p-value | |
Age (mean, [SD]) (years) | 75.2 (13.8) | 74.6 (14.0) | 0.39 | 74.1 (14.3) | 74.5 (14.8) | 0.82 |
Age less than 60 years (5%) | 89 (14.8) | 124 (15.4) | 0.82 | 40 (18.1) | 40 (18.1) | 1.0 |
Female gender (%) | 297 (49.5) | 371 (46.0) | 0.21 | 113 (51.1) | 103 (46.6) | 0.39 |
Billroth-I reconstruction (%) | 21 (3.5) | 19 (2.4) | 0.26 | 9 (4.1) | 8 (3.6) | 1.0 |
Performance status 3 or 4 (%) | 105 (17.5) | 152 (18.9) | 0.53 | 39 (17.6) | 37 (16.7) | 0.90 |
End-stage renal failure requiring dialysis (%) | 20 (3.3) | 22 (2.7) | 0.53 | 10 (4.5) | 5 (2.3) | 0.29 |
Normal serum bilirubin (%) | 299 (49.8) | 331 (41.1) | 0.001 | 104 (47.1) | 97 (43.9) | 0.57 |
Nondilated CBD (<10 mm) (%) | 243 (40.5) | 331 (41.1) | 0.87 | 85 (38.5) | 88 (39.8) | 0.85 |
Large CBD stones (>10 mm) (%) | 106 (17.7) | 148 (18.4) | 0.78 | 40 (18.1) | 42 (19.0) | 0.90 |
Multiple CBD stones (≥2 stones) (%) | 232 (38.7) | 345 (42.8) | 0.13 | 91 (41.2) | 84 (38.0) | 0.56 |
Intradiverticular papilla (%) | 35 (5.8) | 25 (3.1) | 0.016 | 12 (5.4) | 14 (6.3) | 0.84 |
ERCP performed by non-expert endoscopists | 141 (23.5) | 79 (9.8) | <0.001 | 44 (19.9) | 51 (23.1) | 0.49 |
Contrast-assisted cannulation (%) | 274 (45.7) | 731 (90.7) | <0.001 | 176 (79.6) | 176 (79.6) | 1.0 |
PGW-assisted cannulation (%) | 182 (30.3) | 4 (0.5) | <0.001 | 9 (4.1) | 4 (1.8) | 0.26 |
Wire-guided cannulation (%) | 69 (11.5) | 71 (8.8) | 0.11 | 31 (14.0) | 41 (18.6) | 0.25 |
Pancreatic injection (%) | 428 (71.3) | 199 (24.7) | <0.001 | 107 (48.4) | 110 (49.8) | 0.85 |
EST (%) | 512 (85.3) | 714 (88.6) | 0.076 | 194 (87.8) | 191 (86.4) | 0.78 |
EPBD (%) | 74 (12.3) | 89 (11.0) | 0.50 | 25 (11.3) | 29 (13.1) | 0.66 |
EPLBD (%) | 79 (13.2) | 134 (16.6) | 0.084 | 38 (17.2) | 37 (16.7) | 1.0 |
Precut sphincterotomy (%) | 75 (12.5) | 0 (0.0) | <0.001 | 5 (2.3) | 0 (0.0) | 0.061 |
Attempted stone removal (%) | 560 (93.3) | 785 (97.4) | <0.001 | 211 (95.5) | 209 (94.6) | 0.83 |
Balloon (%) | 474 (79.0) | 650 (80.6) | 0.46 | 179 (81.0) | 182 (82.4) | 0.81 |
Basket (%) | 255 (42.5) | 384 (47.6) | 0.058 | 98 (44.3) | 99 (44.8) | 1.0 |
Mechanical lithotripsy (%) | 110 (18.3) | 112 (13.9) | 0.027 | 42 (19.0) | 44 (19.9) | 0.90 |
Biliary stent placement (%) | 513 (85.5) | 686 (85.1) | 0.88 | 194 (87.8) | 188 (85.1) | 0.49 |
Prophylactic pancreatic stent placement (%) | 153 (25.5) | 38 (4.7) | <0.001 | 24 (10.9) | 23 (10.4) | 1.0 |
Complete stone removal (%) | 555 (92.5) | 783 (97.1) | <0.001 | 210 (95.0) | 208 (94.1) | 0.83 |
Rectal NSAIDs (%) | 57 (9.5) | 71 (8.8) | 0.71 | 23 (10.4) | 26 (11.8) | 0.76 |
Protease inhibitor (%) | 247 (41.2) | 235 (29.2) | <0.001 | 104 (47.1) | 87 (39.4) | 0.12 |
Prolonged procedure time (>30min) (%) | 321 (53.5) | 76 (9.4) | <0.001 | 63 (28.5) | 61 (27.6) | 0.92 |
Procedure time (mean, [SD]) (min) | 36.6 (16.5) | 19.5 (9.4) | <0.001 | 27.6 (9.4) | 27.0 (12.4) | 0.63 |
All patients |
Propensity score-matched patients |
|||||
---|---|---|---|---|---|---|
With difficult cannulation (n=600) | Without difficult cannulation (n=806) | p-value | With difficult cannulation (n=221) | Without difficult cannulation (n=221) | p-value | |
PEP (%) | 50 (8.3%) | 13 (1.6%) | <0.001 | 12 (5.4%) | 3 (1.4%) | 0.032 |
With difficult cannulation (n=600) | Without difficult cannulation (n=806) | p-value | |
---|---|---|---|
Age (mean, [SD]) (years) | 75.2 (13.8) | 74.6 (14.0) | 0.39 |
Female gender (%) | 297 (49.5) | 371 (46.0) | 0.21 |
Absence of acute cholangitis (%) | 238 (39.7) | 243 (30.1) | <0.001 |
Normal serum bilirubin (%) | 299 (49.8) | 331 (41.1) | 0.001 |
Nondilated CBD (<10 mm) (%) | 243 (40.5) | 331 (41.1) | 0.87 |
Performance status 3 or 4 (%) | 105 (17.5) | 152 (18.9) | 0.53 |
Billroth-1 reconstruction (%) | 21 (3.5) | 19 (2.4) | 0.26 |
Intradiverticular papilla (%) | 35 (5.8) | 25 (3.1) | 0.016 |
Appearance of the major duodenal papilla (%) | 0.002 | ||
Type 1 | 265 (44.2) | 358 (44.4) | |
Type 2 | 276 (46.0) | 342 (42.4) | |
Type 3 | 26 (4.3) | 74 (9.2) | |
Type 4 | 33 (5.5) | 32 (4.0) | |
ERCP performed by non-expert endoscopists | 141 (23.5) | 79 (9.8) | <0.001 |
Low-volume center (%) | 170 (28.3) | 140 (17.4) | <0.001 |
Multiple CBD stones (≥2 stones) (%) | 232 (38.7) | 345 (42.8) | 0.13 |
Large CBD stones (>10 mm) (%) | 106 (17.7) | 148 (18.4) | 0.78 |
History of cholecystectomy (%) | 59 (9.8) | 97 (12.0) | 0.20 |
Presence of gallstones (%) | 386 (64.3) | 495 (61.4) | 0.27 |
Odds ratio | 95% CI | p-value | |
---|---|---|---|
ERCP performed by nonexpert endoscopists | 2.5 | 1.9-3.5 | <0.001 |
Low-volume center | 1.6 | 1.2-2.1 | <0.001 |
Intradiverticular papilla | 1.3 | 1.1-1.5 | 0.007 |
Normal serum bilirubin | 1.3 | 1.01-1.7 | 0.038 |
Absence of acute cholangitis | 1.3 | 1.00-1.7 | 0.049 |
Appearance of the major duodenal papilla | 0.98 | 0.85-1.1 | 0.77 |
CBD, common bile duct; EPBD, endoscopic papillary balloon dilation; EPLBD, endoscopic papillary large balloon dilation; ERCP, endoscopic retrograde cholangiopancreatography; EST, endoscopic sphincterotomy; NSAIDs, nonsteroidal anti-inflammatory drugs; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; PGW, pancreatic guidewire; SD, standard deviation.
ERCP, endoscopic retrograde cholangiopancreatography; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; SD, standard deviation.
CI, confidence interval; ERCP, Endoscopic retrograde cholangiopancreatography.