Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 20-28
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.20
Acute distal common bile duct angle is risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis in beginner endoscopist
Sung Yong Han, Dong Uk Kim, Moon Won Lee, Young Joo Park, Dong Hoon Baek, Gwang Ha Kim, Geun Am Song
Sung Yong Han, Dong Uk Kim, Moon Won Lee, Young Joo Park, Dong Hoon Baek, Gwang Ha Kim, Geun Am Song, Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Author contributions: Kim DU and Kim GH designed research; Han SY, Lee MW and Park YJ performed research; Han SY, Baek DH contributed analytzed data; Han SY wrote the paper; Kim DU and Song GA contributed critical revision of the paper.
Supported by Biomedical Research Institute Grant, No. 2019B021, Pusan National University Hospital.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Pusan National University Hospital.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This is an open-access article that 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: Dong Uk Kim, MD, PhD, Assistant Professor, Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Gudeok ro 179, Seo-gu, Busan 49241, South Korea. amlm3@hanmail.net
Received: October 14, 2019
Peer-review started: October 14, 2019
First decision: December 4, 2019
Revised: December 4, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: January 6, 2020
Abstract
BACKGROUND

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a critical and poorly managed complication of ERCP. Endoscopists need to understand the risk factors for PEP. However, the majority of studies investigating ERCP-related risk factors have included well-trained endoscopists, with the issue of endoscopist experience on PEP incidence not having been systematically evaluated.

AIM

To explore the risk factors for PEP in beginner endoscopists without supervision.

METHODS

We performed a retrospective analysis of 293 patients, with naïve papilla and no history of pancreatitis, treated using bile duct cannulation. Patients were classified according to the endoscopist’s experience (beginner vs expert). The angle of the distal common bile duct (CBD) was measured as the angle between the lower wall of the bile duct and a vertical line extending to the lower wall of the bile duct on coronal view computed tomography.

RESULTS

After propensity matching, there were no differences between patients treated by the expert and beginner endoscopist with regard to age, sex, mean bile duct dilatation, and ratio of benign disease. The distal CBD angle was classified as acute (> 30º) or obtuse (≤ 30º), based on the mean angle of 29.9º for the group. An acute distal CBD angle was a significant risk factor for PEP for beginner (P = 0.049), but not expert.

CONCLUSION

For beginner endoscopists first performing unsupervised ERCP, cases with an obtuse distal CBD angle may be more appropriate to lower the risk of PEP.

Keywords: Common bile duct angle, Endoscopic retrograde cholangiopancreatography, Novice learner, Pancreatitis, Risk factor, Begginer endoscopist

Core tip: The most studies investigating endoscopic retrograde cholangiopancreatography (ERCP)-related risk factors have included well-trained endoscopists, with the issue of endoscopist experience on post-ERCP pancreatitis (PEP) incidence not having been systematically evaluated. Our retrospective study aims to explore the risk factors for PEP in beginner endoscopists without supervisor. Our data showed that acute distal common bile duct (CBD) angle was the only significantly risk factor of PEP in novice endoscopist. The acute distal CBD angle could be known before the procedure. Therefore, beginners can avoid these cases or perform with supervisor to reduce the PEP rate. Obtuse distal CBD angle may be more appropriate to beginner endoscopist.