Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2016; 4(8): 213-218
Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.213
Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire
Yuji Sakai, Toshio Tsuyuguchi, Harutoshi Sugiyama, Masahiro Hayashi, Jun-ichi Senoo, Reina Sasaki, Yuko Kusakabe, Masato Nakamura, Shin Yasui, Rintaro Mikata, Masaru Miyazaki, Osamu Yokosuka
Yuji Sakai, Toshio Tsuyuguchi, Harutoshi Sugiyama, Masahiro Hayashi, Jun-ichi Senoo, Reina Sasaki, Yuko Kusakabe, Masato Nakamura, Shin Yasui, Rintaro Mikata, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba City 260-8670, Japan
Masaru Miyazaki, Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba City 260-8670, Japan
Author contributions: Sakai Y wrote the paper; Sakai Y and Tsuyuguchi T performed endoscopic treatments; Sakai Y, Tsuyuguchi T, Miyazaki M and Yokosuka O were responsible for the study’s design, data analysis, and manuscript preparation; Sugiyama H, Hayashi M, Senoo J, Sasaki R, Kusakabe Y, Nakamura M, Yasui S and Mikata R were responsible for data collection.
Institutional review board statement: This study was conducted with the agreement of our ethical committee.
Informed consent statement: All the treatment procedures were performed after obtaining the patients’ informed consent in writing.
Conflict-of-interest statement: The authors have no other disclosures.
Data sharing statement: All researchers had equal access to the data.
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/
Correspondence to: Yuji Sakai, MD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City 260-8670, Japan. sakai4754@yahoo.co.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: February 25, 2016
Peer-review started: February 27, 2016
First decision: April 15, 2016
Revised: May 2, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: August 16, 2016
Processing time: 169 Days and 4.1 Hours
Abstract

AIM: To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a loop-tipped guidewire.

METHODS: Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire (Group A, 20 patients), and a conventional straight-type guidewire (Group B, 20 patients).

RESULTS: The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23 (0-1) times in Group A and 2.3 ± 1.84 (0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4 (88-628) IU/L in Group A, and 552.05 ± 534.57 (101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients (10%) in Group A, and nine (45%) in Group B, showing a significantly lower value in Group A.

CONCLUSION: The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia.

Keywords: Hyperamylasemia; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Guidewire

Core tip: The results suggest that a loop-tipped guidewire inserted in the pancreatic duct during stenting in patients who experience difficulties with selective biliary duct cannulation has the potential to assist with prevention of unintended insertion of the guidewire into side branches of the pancreatic duct, and thereby contribute to a reduced risk of post-endoscopic retrograde cholangiopancreatography pancreatitis or hyperamylasemia.