Retrospective Study Acute distal common bile duct angle is risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis in beginner endoscopist

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 naive 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.