Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis: From divination to science

Table 2 Comparison of procedure-related risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis by multivariate analysis in the classic article and current knowledge by meta-analysis or multivariate studies

Risk factors in the classic article	Current knowledge1
Significant in multivariate analysis	High risk factors
Difficult cannulation	Difficult or failed cannulation
Balloon dilation of biliary sphincter	Balloon dilation of biliary sphincter
Pancreatic sphincterotomy	Pancreatic sphincterotomy
≥ 1 pancreatic contrast injections	Pancreatic duct injection
	Precut sphincterotomy
	Failed attempts at placing pancreatic duct stent
Significant only in univariate analysis	Possible risk factors
Sphincter of Oddi manometry	Ampullectomy
Pancreatic stent placement	Pancreatic acinarization
Minor papilla cannulation	Pancreatic brush cytology
Precut (access) papillotomy	Failure to clear bile duct stones
≥ 1 pancreatic deep wire pass/cannulation	Involvement of trainee during ERCP
Endoscopist performing > 2 ERCP/wk
Not significant	Not related
Acinarization of pancreas	Sphincter of Oddi manometry (using aspirated catheter)
Biliary sphincterotomy	Biliary sphincterotomy
Intramural contrast injection	Intramural contrast injection
Pancreatic stricture dilation by any method	Prior failed ERCP
Pancreatic duct tissue sampling by any method	Therapeutic vs diagnostic
Training fellow involved

¹Current knowledge is based on recent guidelines by American Society for Gastrointestinal Endoscopy[6] and European Society of Gastrointestinal Endoscopy[5], and relevant articles[3,22]. ERCP: Endoscopic retrograde cholangiopancreatography.