Difficult cannulation is the most important factor for post-ERCP pancreatitis: What is the mechanism?

摘要

I read with great interest the study by Mariani et al1 describing that guidewire biliary cannulation does not reduce post-ERCP pancreatitis (PEP) compared with the contrast injection technique in low-risk and high-risk patients. PEP occurred in 35 of 678 patients (5.2%) in the guidewire biliary cannulation group and 25 of 571 patients (4.4%) in the contrast injection group (not significant). In their study, the guidewire biliary cannulation technique did not prevent the trauma to the papilla more than the contrast injection technique, as confirmed by the similar number of cannulation attempts with the two techniques, a parameter used to grade the difficulty of cannulation.