Author/Authors :
Hirose, Sumio First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Fukasawa, Mitsuharu First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Takano, Shinichi First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Kadokura, Makoto First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Shindo, Hiroko First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Takahashi, Ei First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Yokota, Yudai First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Fukasawa, Yoshimitsu First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Kawakami, Satoshi First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Hayakawa, Hiroshi First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Sato, Tadashi First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan , Enomoto, Nobuyuki First Department of Internal Medicine - Faculty of Medicine - University of Yamanashi, Japan
Abstract :
Background and Aims
The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention.
Methods
This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW.
Results
The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22–0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30–0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61–8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09–0.85, P = 0.02).
Conclusions
Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.
