Yahya ATAYAN

The relationship between sphincteratomy methods and post ercp pancreatitis

Post (ERCP) pancreatitis (PEP) is the most commonly seen complication after endoscopic retrograde cholangio-pancreaticography (ERCP). It is associated with pancreatic hyperamylasemia and persistent abdominal pain. It can be classified as mild, moderate and severe. During ERCP, bile ducts or pancreatic duct can be cannulated using standard sphincteratomy or needle-tipped sphincteratomy methods and contrast material is injected in order to view these ducts. In this study, we aimed to examine whether the use of sphincterotomy methods and pancreatic canal interventions poses a risk in the development of PEP, which is the most common complication after ERCP. Of the 445 patients who underwent ERCP, 270 had standard sphincterotomy and 175 had Needle-knife sphincterotomy (NKS). Patients who were cannulated with pancreatic duct and injected with contrast agent during the procedure and patients who were diagnosed with PEP according to the revised Atlanta criteria, were included in the study. Of 445 patients, 187 were male (39.7%) and 258 were female (60.3%). After successful sphincterotomy, stone extraction basket and / or balloon procedure was applied to all patients. Of the 270 patients, 13(2.9%) patients developed PEP and 9 of these patients had pancreatic duct cannulation and contrast agent injection during the procedure. PEP development was statistically significant in patients with pancreatic duct cannulation (p

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Freeman ML. Adverseoutcomes of ERCP. Gastrointest Endosc. 2002;56:27382.

Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1-10.

Testoni PA, Bagnolo F. Pain at 24 hours associated with amylase levels greater than 5 times the upper normal limit as the most reliable indicator of post-ERCP pancreatitis. Gastrointest Endosc. 2001;53:33-9.

Lerch MM. Classifying an unpredictabledisease: therevised Atlanta classification of acutepancreatitis. Gut. 2013;62:2-3.

Badalov N, Tenner S, Baillie J. The Prevention, recognition and treatment of post-ERCP pancreatitis. JOP 2009;10:88-97.

Mariani A, Giussani A, DiLeo M, et al. Guide wire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients. Gastrointest Endosc. 2012;75:339-46.

Choudhary A, Bechtold ML, Arif M, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73:275-82.

Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004;60:544-50.

Freeman ML, Guda NM. Prevention of post- ERCP pancreatitis: a comprehensive review. Gastrointest Endosc. 2004;59:845-64.

Akashi R, Kiyozumi T, Tanaka T, Mechanism of pancreatitis caused by ERCP. Gastrointest Endosc. 2002;55:50-4.

De Weerth A, Seitz U, Zhong Y et al, Primary precutting versus conventional over- the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy. 2006;38:1235-40.

Zhou PH, Yao LQ, Xu MD, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2006;5:590-4.

Ahmad I, Khan, AA, Alam, A, Butt AK, et al. Precut papillotomy outcome. Journal of the college of physicians and surgeons- Pakistan: JCPSP, 2005;15:701-3.

Lawrence C, Romagnuolo J, Cotton PB.et al. Post-ERCP pancreatitis rates do not differ between needle- knife and pull- type pancreatic sphincterotomy techniques: a multi endoscopist 13-year experience. Gastrointest Endosc. 2009;69:1271-5.

Siddiqui AR,Niaz SK. Needle knife papillotomy for cannulating difficult papilla; two years experience. JPMA. J Pak Med Assoc. 2008;58:195-7.

Bailey AA, Bourke MJ, Kaffes AJ. Needle- knife sphincterotomy: factors predicting its use and therelationship with post-ERCP pancreatitis. Gastrointest Endosc. 2010;71:266-71.