Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury

Table 1 Inclusion and exclusion criteria

Inclusion criteria

Clinical and radiological findings fulfilling indication for cholecystectomy due to gallstone

Clinical and radiological findings fulfilling indication for ERCP due to CBDS

Adult, ≥ 18 yr

Informed consent

Exclusion criteria

Acute or chronic pancreatitis

Acute cholangitis

Acute cholecystitis

Antiinflammatory medication

Failure to perform cholangiography

Pancreatic or biliary cancer

Prior ERCP with sphincterotomy

Conversion from laparoscopic to open cholecystectomy

ERCP: Endoscopic retrograde cholangiopancreatography; CBDS: Common bile duct stones.

Table 2 Preoperative demographic characteristics (n = 122)

Group	CV ERCP (n = 41)	RV ERCP (n = 40)	LC control2 (n = 41)	P value
Female	24 (59)	31 (77)	33 (80)	0.06
Age, (yr)	64 ± 14	47 ± 16	50 ± 15	0.003
Body mass index	29 ± 8.1	27 ± 5.9	27 ± 4.9	0.21
Physical status, ASA-score				0.33
Grade 1	12 (29)	20 (50)	20 (49)
Grade 2	23 (56)	16 (40)	16 (39)
Grade 3	6 (15)	4 (10)	5 (12)
Laboratory values, median (25th-75th)
Bilirubin, < 26 mmol/L	28.0 (9.0-97.5)	29.0 (10.0-81.0)	9.0 (7.0-16.0)	1.001
Alkaline phosphatase, < 1.9 μcat/L	3.9 (2.2-5.8)	2.4 (1.6-4.4)	1.8 (1.1-2.8)	0.601
C-reactive protein, < 10 mg/L	5.0 (5.0-14.0)	5.0 (5.0-5.0)	5.0 (5.0-5.0)	0.541
Pancreatic amylase, 0.15-1.10 μcat/L	0.4 (0.3-0.7)	0.4 (0.3-0.5)	0.4 (0.3-0.6)	0.561
Procarboxypeptidase B, nmol/L	7.9 (5.4-16.3)	5.4 (3.5-7.4)	5.3 (3.0-9.5)	0.871
Trypsinogen-2, 30-110 μg/L	126.0 (83.0-208.4)	118.0 (86.3-132.6)	88.5 (68.6-142.3)	0.391

Data are expressed as mean ± SD or n (%).

¹Conventional endoscopic retrograde cholangiopancreatography (CV ERCP) vs rendezvous ERCP (RV ERCP);

²Laparoscopic cholecystectomy (LC) without ERCP. ASA: American Society of Anesthesiologists.

Table 3 Clinical outcome and biometric results at 4-, 8- and 24 h after conventional endoscopic retrograde cholangiopancreatography, rendezvous endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy alone (n = 122)

Group	CV ERCP (n = 41)	RV ERCP (n = 40)	LC control1 (n = 41)	P-value
Difficult cannulation, > 6 attempts	9 (22)	0 (0)	NA	0.002a
Precut techniques	6 (15)	0 (0)	NA	0.03a
Cannulation failure	3 (7)	0 (0)	NA	0.24
Pancreatic cannulation	13 (32)	0 (0)	NA	< 0.001a
Pancreatic duct opacification	11 (27)	0 (0)	NA	0.001a
Stone clearance at index procedure	33 (81)	38 (95)	NA	0.01a
Stone size	6.4 ± 5.1	5.5 ± 3.2	NA	0.40
Median endoscopic procedure time, minutes (range)	36 (10-80)	28 (17-55)	NA	0.11
Post ERCP pancreatitis	3 (7)	0 (0)	0 (0)	0.24
Hyperamylasemia, > 3 fold rise above upper reference value, with or without post ERCP pancreatitis	6 (15)	0 (0)	0 (0)	0.03a
Pancreatic amylase (μcat/L), 4 h	2.0 ± 4.2	0.5 ± 0.3	0.4 ± 0.3	0.0015a
Pancreatic amylase (μcat/L), 8 h	3.5 ± 9.0	0.6 ± 0.3	0.5 ± 0.3	0.03a
Pancreatic amylase (μcat/L), 24 h	2.4 ± 6.0	0.6 ± 0.3	0.4 ± 0.2	0.056
Procarboxypeptidase B (nmol/L), 4 h	90.7 ± 237.7	7.2 ± 8.1	6.5 ± 9.3	< 0.0001a
Procarboxypeptidase B (nmol/L), 8 h	111.7 ± 287.3	7.9 ± 7.9	8.0 ± 18.4	< 0.0001a
Procarboxypeptidase B (nmol/L), 24 h	47.4 ± 131.7	8.5 ± 7.9	8.2 ± 9.2	< 0.0001a
Trypsinogen-2 (μg/L) 24 h	317.8 ± 547.1	145.6 ± 67.2	134.0 ± 80.2	0.03a

Data are expressed as mean ± SD or n (%). P-value indicate differences between conventional endoscopic retrograde cholangiopancreatography (CV ERCP) vs rendezvous ERCP (RV ERCP) and

^aP < 0.05.

¹Laparoscopic cholecystectomy (LC) without ERCP. NA: Not applicable.