Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2019; 11(10): 515-522
Published online Oct 16, 2019. doi: 10.4253/wjge.v11.i10.515
Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones
Hirokazu Saito, Tatsuyuki Kakuma, Ikuo Matsushita
Hirokazu Saito, Ikuo Matsushita, Department of Gastroenterology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-ku, Kumamoto City, Kumamoto 862-0965, Japan
Tatsuyuki Kakuma, Department of Biostatics Center, Medical School, Kurume University, 67, Asahimachi, Kurume City, Fukuoka 830-0011, Japan
Author contributions: All authors equally contributed to the following criteria for authorship: Conception and design, analysis and interpretation of data, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article.
Institutional review board statement: This study was reviewed and approved by the institutional review boards of both participating institutions: Kumamoto Chuo Hospital, Kumamoto City Hospital and Saiseikai Kumamoto Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patients agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to declare in relation to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hirokazu Saito, MD, Chief Doctor, Department of Gastroenterology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-ku, Kumamoto City, Kumamoto 862-0965, Japan. arnestwest@yahoo.co.jp
Telephone: +81-96-3703111 Fax: +81-96-3704017
Received: May 5, 2019
Peer-review started: May 8, 2019
First decision: August 2, 2019
Revised: August 21, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 16, 2019
Processing time: 165 Days and 8.9 Hours
ARTICLE HIGHLIGHTS
Research background

Previous studies have revealed that patients with asymptomatic common bile duct (CBD) stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.

Research motivation

Treatment for asymptomatic CBD stones through ERCP aims at the prevention of possible complications associated with the presence of CBD stones. Furthermore, this disease is benign and asymptomatic. Therefore, complete removal of stones through ERCP with a low risk of PEP development is important, particularly in patients with asymptomatic CBD stones. We identified the risk factors for PEP in this population to reduce the incidence of PEP.

Research objectives

The objective of this study was to examine the risk factors for the development of PEP in patients with asymptomatic CBD stones.

Research methods

We reviewed the medical records of three Japanese hospital from April 2012 to March 2018 and identified 1135 patients with choledocholithiasis–including acute cholangitis, biliary pancreatitis, obstructive jaundice or elevated liver test results without cholangitis, and asymptomatic CBD stones-who were diagnosed with native papilla and gastrointestinal tract without a surgical history or Billroth I reconstruction and who underwent endoscopic sphincterotomy, endoscopic papillary balloon dilation, or endoscopic papillary large balloon dilation. Of these, 168 patients with asymptomatic CBD stones were enrolled in this study. We performed univariate and multivariate analyses to identify the risk factors for PEP development in patients with asymptomatic CBD stones.

Research results

Among all the 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients, the incidence rate of PEP was 4.7% (53/1135). Of the 168 patients with asymptomatic CBD stones, 24 (14.3%) developed PEP. In univariate analysis, precut sphincterotomy and biliary balloon sphincter dilation were identified as significant risk factors for PEP development in patients with asymptomatic CBD stones. In multivariate analysis, precut sphincterotomy, biliary balloon sphincter dilation, and trainee endoscopists were identified as significant risk factors for PEP development in this population.

Research conclusions

ERCP for asymptomatic CBD stones should be performed by experienced endoscopists. When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones, prophylactic pancreatic stent placement is strongly recommended to prevent PEP.

Research perspectives

An important limitation of this study was that this was a retrospective study with small cohort. Prospective studies with a large number of patients are warranted to further identify the risk factors associated with the development of PEP in patients with asymptomatic CBD stones.