Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Although multiple pancreatic duct (PD) cannulations are a known risk factor for PEP, the impact of single cannulations remains controversial. We aimed to identify whether single PD cannulation is associated with PEP.We conducted a prospective multicenter study in patients undergoing ERCP for biliary indications during 2021-2024, with third-party intra-procedural data recording and 30-day follow-up. PEP was defined using consensus definitions. Associations between PD cannulations and PEP were evaluated with multivariable logistic regression, with other patient- and procedure-related risk factors and preventative interventions used as covariates. Results were reported as odds ratios (ORs).PEP occurred in 282 (3.8%) of 7430 ERCPs across nine centers. From multivariable analysis, PD cannulation was statistically significantly associated with PEP, with similar odds for single and multiple cannulations in first-time patients (OR 2.03 [95%CI 1.32-3.14] for single, OR 2.18 [95%CI 1.18-4.00] for ≥5 cannulations) and all patients (OR 1.97 [95%CI 1.33-2.93] for single, OR 2.15 [95%CI 1.21-3.82] for ≥5). PD cannulation to the head (OR 2.09 [95%CI 1.36-3.21]) and body (OR 2.43 [95%CI 1.56-3.79]) were both associated with PEP, while side-branch cannulations alone were not (OR 1.18 [95%CI 0.64-2.06]).Single main PD duct cannulation was independently associated with PEP and appeared to be responsible for most of the magnitude of the association with PD cannulation. These data support the use of preventative interventions such as PD stenting in cases where the PD is inadvertently cannulated.

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Journal
Endoscopy
Published
2025-08-04
DOI
https://doi.org/10.1055/a-2675-4322
Citations
1
Primary Topic
Gallbladder and Bile Duct Disorders
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article
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article

Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data

Natalia Causada Calo, Steven J. Heitman, Nirav C Thosani, Megan Howarth et al.
1 citations
Endoscopy
Gallbladder and Bile Duct Disorders
1.52
article

Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data

Natalia Causada Calo, Steven J. Heitman, Nirav C Thosani, Megan Howarth, Andrew Singh, Samir C. Grover, Alejandra Tepox-Padrón, Yang Lei, Christian Turbide, Avijit Chatterjee, Nauzer Forbes, Rachid Mohamed, Shane Cartwright, Howard Guo, B. Joseph Elmunzer, Yen‐I Chen, Millie Chau, Suqing Li, Lawrence Hookey, Yousef Alshammari, Zhao Wu Meng, Sara Ficaccio, Mehul Gupta, Naveen Arya, Peter D. Siersema
article en
1 citations

Abstract

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Although multiple pancreatic duct (PD) cannulations are a known risk factor for PEP, the impact of single cannulations remains controversial. We aimed to identify whether single PD cannulation is associated with PEP.We conducted a prospective multicenter study in patients undergoing ERCP for biliary indications during 2021-2024, with third-party intra-procedural data recording and 30-day follow-up. PEP was defined using consensus definitions. Associations between PD cannulations and PEP were evaluated with multivariable logistic regression, with other patient- and procedure-related risk factors and preventative interventions used as covariates. Results were reported as odds ratios (ORs).PEP occurred in 282 (3.8%) of 7430 ERCPs across nine centers. From multivariable analysis, PD cannulation was statistically significantly associated with PEP, with similar odds for single and multiple cannulations in first-time patients (OR 2.03 [95%CI 1.32-3.14] for single, OR 2.18 [95%CI 1.18-4.00] for ≥5 cannulations) and all patients (OR 1.97 [95%CI 1.33-2.93] for single, OR 2.15 [95%CI 1.21-3.82] for ≥5). PD cannulation to the head (OR 2.09 [95%CI 1.36-3.21]) and body (OR 2.43 [95%CI 1.56-3.79]) were both associated with PEP, while side-branch cannulations alone were not (OR 1.18 [95%CI 0.64-2.06]).Single main PD duct cannulation was independently associated with PEP and appeared to be responsible for most of the magnitude of the association with PD cannulation. These data support the use of preventative interventions such as PD stenting in cases where the PD is inadvertently cannulated.

EndoscopyVol. 58(02)
St. Michael's Hospital (CA), University Health Network (CA), Medical University of South Carolina (US), University of Ottawa (CA), University of Calgary (CA), University of Toronto (CA), Queen's University (CA), University of Victoria (CA), Scarborough Health Network (CA), Ottawa Hospital (CA), Oakville-Trafalgar Memorial Hospital (CA), Erasmus MC (NL), Victoria General Hospital (CA), Victoria General Hospital (CA), The University of Texas Health Science Center (US), McGill University (CA), Erasmus University Rotterdam (NL), The University of Texas Health Science Center at Houston (US), McMaster University (CA)
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Openalex Percentile: Top 16%
Gallbladder and Bile Duct Disorders
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