Video-Based Analysis of Risk Factors for Post-ERCP Pancreatitis in Pancreatic Guidewire-Assisted Biliary Cannulation

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Pancreatology

Background:

• The pancreatic guidewire (PGW) technique is a salvage method for challenging biliary cannulation during ERCP.
• Risk factors for post-ERCP pancreatitis (PEP) specifically within PGW cases are not well-defined.
• Detailed intraprocedural and morphological factors influencing PEP in PGW use require further investigation.

Purpose of the Study:

• To identify risk factors for PEP in patients undergoing PGW-assisted biliary cannulation.
• To analyze detailed intraprocedural and papillary morphological factors using video recordings.
• To improve risk stratification and decision-making for difficult biliary cannulation.

Main Methods:

• Retrospective analysis of ERCP procedures using PGW for naïve papillae (August 2017-January 2023).
• Analysis of endoscopic and fluoroscopic videos to extract papillary morphology and procedural variables.
• Multivariable logistic regression to determine independent risk factors for PEP.

Main Results:

• Out of 178 analyzed cases, PEP occurred in 11.2% of patients.
• Cannulation time ≥ 20 minutes (OR 3.53) and short oral papilla protrusion < 10 mm (OR 3.01) were independently associated with PEP.
• Guidewire insertion into a pancreatic side branch showed a trend towards increased PEP risk (OR 2.48).

Conclusions:

• Prolonged cannulation time and short oral papilla protrusion are significant risk factors for PEP in PGW-assisted biliary cannulation.
• Pancreatic side-branch guidewire insertion may also contribute to PEP risk.
• These findings aid in refining risk assessment and guiding prophylactic strategies for difficult biliary cannulation.