Endoscopic prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Table 1 Prospective randomized trials of wire-guided cannulation to reduce the incidence of post- endoscopic retrograde cholangiopancreatography pancreatitis

	n	Design	Pancreatitis (n)/accidental PD (n)	Post-ERCP pancreatitis n/n (%)		P value
			(WGC vs CC)1	WGC	CC
Lella et al[25]	200/200	Prospective/Randomized	0/82, 5/113	0/197 (0)	8/195 (4.1)	< 0.01
Artifon et al[23]	150/150	Prospective/Randomized	0/27, 4/21	13/150 (8.6)	25/150 (16.6)	0.02
Bailey et al[24]	202/211	Prospective/Randomized	NA	16/202 (7.9)	13/211 (6.2)	0.48
Katsinelos et al[26]	167/165	Prospective/Comparative	NA	9/167 (5.4)	13/165 (7.9)	0.37
Lee et al[22]	150/150	Prospective/Randomized	2/39, 8/44	3/150 (2)	17/150 (11.3)	0.001
Mariani et al[28]	678/571	Prospective/Comparative	15/99, 8/95	35/678 (5.2)	25/ 571 (4.4)	0.60
Kawakami et al[29]	199/201	Prospective/Randomized2	NA	8/199 (4.0)	6/201 (2.9)	NS

¹The number of post-ERCP pancreatitis following accidental PD injection or cannulation in CC and WGC group;

²Multicenter RCT with a 2 × 2 factorial design. 0/82 vs 5/113, P = 0.08; 0/27 vs 4/21, P = 0.05; 2/39 vs 8/44, P = 0.09 by Fisher’s exact test. PD: Pancreatic duct cannulation or contrast injection; WGC: Wire-guided cannulation; CC: Conventional cannulation; NS: Not significant; NA: Not available.

Table 2 Studies for the use of pancreatic stents to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis

Study	Design	Indications	PEP rate
			n	Non-stent/stent (%)	P value
Smithline et al[63]	RCT	Biliary ES for SOD, small ducts, or precut	93	18/14	0.229
Aizawa and Ueno[31]	Retrospective case-control	Biliary balloon dilatation for stone	40	6/0	0.110
Fogel et al[18]	Retrospective case-control	Biliary ± pancreatic ES for SOD	436	28.2/13.5	< 0.05
Fazel et al[32]	RCT	Difficult cannulation, biliary ES, SOD	76	28/5	< 0.05
Freeman et al[19]	Prospective case-control	Consecutive high-risk ERCP in which a major papilla PD stent was attempted	225	66.7/14.4	0.060
Harewood et al[58]	RCT	Endoscopic ampullectomy	19	33/0	0.020
Sofuni et al[64]	RCT	All consecutive ERCP (excluding pancreatic cancer, pancreas divisum, PD therapy cases)	201	13.6/3.2	0.020
Tsuchiya et al[66]	RCT	All consecutive ERCP irrespective of risk factors	64	12.5/3.1	> 0.05
Saad et al[70]	Retrospective nonrandomized	Suspected SOD and normal manometry	403	9/2.4	0.006
Lee et al[59]	RCT	Difficult biliary cannulation	101	29.4/12	0.031

ES: Endoscopic sphincterotomy; SOD: Sphincter of Oddi dysfunction; RCT: Randomize controlled study; PD: Pancreatic duct; PEP: Post-ERCP pancreatitis.

Table 3 Efficacy of 3- vs 5-F pancreatic stents in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

	Technical success	Spontaneous migration	PEP	Stents
Rashdan et al[61] (3 F vs 4, 5, 6 F)	NA	86%/73%/67%/65%1 (P < 0.01)	7.5%/10.6%/9.8%/14.6% (P = 0.047)	COOK, 4-12 cm
Chahal et al[56] (3 F vs 5 F)	91%/100% (P = 0.0003)	88%/98% (P = 0.0001)2	14%/9% (P = 0.3)	3 F, 8 and 10 cm/5 F, 3 cm
Zolotarevsky et al[69] (3 F vs 5 F)	97.5%/100%	75%/68.4% (P = 0.617)2	17.5%/10.5% (P = 0.519)	COOK, Zimmon 3 F, 3 cm/ 5 F, 5 cm

¹10-14 d;

²2 wk. PEP: Post-ERCP pancreatitis; NA: Not available.