Impact of intraduodenal acetic acid infusion on pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography: A double-blind, randomized controlled trial.

Published on Oct 1, 2018in Journal of Gastroenterology and Hepatology3.437
· DOI :10.1111/JGH.14148
Jun Fang4
Estimated H-index: 4
(WHU: Wuhan University),
Shu-Ling Wang8
Estimated H-index: 8
('SMMU': Second Military Medical University)
+ 8 AuthorsYu Bai20
Estimated H-index: 20
BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with risk of complications. Methods to facilitate ductal cannulation may reduce complications. Intraduodenal acid infusion is a physiological approach to stimulate secretin release in human body and may facilitate cannulation. The objective of this study was to investigate the effect of intraduodenal acid infusion on pancreatic duct cannulation during ERCP. METHODS: It was a single center, double-blind, randomized controlled trial. Consecutive patients undergoing first ERCP for pancreatic diseases were randomized toreceive 50 mL acetic acid intraduodenal infusion at ERCP (acetic acid group) or 50 mL saline (control group). The primary outcome, difficult cannulation rate (cannulation time >5 min), in the two groups was compared. RESULTS: Two hundred ten patients were included in the final analysis (105 in each group). The difficult cannulation rate were 39.1% in the control group and 20.9% in the acetic acid group, and the difference was statistically significant (P = 0.004). The overall successful deep cannulation rate was 89.5% and 85.7%, respectively (P = 0.402). The cannulation time was remarkably shortened (182 vs 286 s, P = 0.018), and the cannulation attempts were significantly decreased (3.4 vs 4.4, P = 0.008). The fluoroscopy time was also significantly reduced (60 vs 86 s, P = 0.028). The incidence of post-ERCP pancreatitis and hyperamylasemia was comparable (7.6% vs 10.5% and 10.5% vs 19.1%, P > 0.05). CONCLUSION: Intraduodenal acetic acid infusion can significantly decrease difficult pancreatic cannulation rate, facilitate pancreatic duct cannulation, and reduce radiation exposure ( number, NCT02800772).
#1Zhen-Hua Zhao ('SMMU': Second Military Medical University)H-Index: 3
#2Liang-Hao Hu ('SMMU': Second Military Medical University)H-Index: 17
Last. Zhuan Liao ('SMMU': Second Military Medical University)H-Index: 19
view all 14 authors...
Background and Aims Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort. Methods In this observational cohort stud...
19 CitationsSource
#1Yu Bai ('SMMU': Second Military Medical University)H-Index: 20
#2Shu-Ling Wang ('SMMU': Second Military Medical University)H-Index: 8
Last. Zhao-Shen Li ('SMMU': Second Military Medical University)H-Index: 59
view all 5 authors...
1 CitationsSource
#1Pier Alberto Testoni (UniSR: Vita-Salute San Raffaele University)H-Index: 39
#2Alberto Mariani (UniSR: Vita-Salute San Raffaele University)H-Index: 27
Last. Earl J. Williams (Royal Bournemouth Hospital)H-Index: 4
view all 20 authors...
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE suggests that difficult biliary cannulation is defined by the presence of one or...
174 CitationsSource
#1Liang-Hao Hu ('SMMU': Second Military Medical University)H-Index: 17
#2Bo YeH-Index: 14
Last. Zhao-Shen LiH-Index: 59
view all 10 authors...
This study aims to evaluate prospectively the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in Chinese patients.A total of 214 patients with painful chronic pancreatitis and pancreatic stones who underwent ESWL followed by endoscopic retrograde cholangiopancreatography from March 2011 to February 2012 in Changhai Hospital were enrolled. The main pancreatic duct clearance rate and complications were recorded prospectively. Symptoms, weight, quality of life, and pancreatic fu...
25 CitationsSource
#1Yu Bai ('SMMU': Second Military Medical University)H-Index: 20
#2Xu RenH-Index: 5
Last. Zhao-Shen Li ('SMMU': Second Military Medical University)H-Index: 59
view all 12 authors...
Background and study aim: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most common complication of ERCP. Somatostatin may inhibit pancreatic secretion and has been tested for PEP prophylaxis. However, the results of previous studies are inconsistent. The aim of the current study was to investigate whether somatostatin can reduce the incidence of PEP. Patients and methods: The study was a multicenter, open-label, randomized controlled trial. A total of...
17 CitationsSource
#1Mihir S. Wagh (UF: University of Florida)H-Index: 25
#2Ahmed E. Mukhtar (IU: Indiana University)H-Index: 2
Last. Glen A. Lehman (IU: Indiana University)H-Index: 89
view all 10 authors...
Background A fatty meal before ERCP relaxes the sphincter of Oddi and may facilitate biliary cannulation. Objective To assess the effect of an oral fatty meal before ERCP on time to and success rate of biliary cannulation. Design Human clinical study. Setting Tertiary ERCP center. Patients Adult patients with intact papilla undergoing ERCP for presumed biliary pathology. Interventions Patients arriving more than 1 hour before the procedure were given oil by mouth. Patients not receiving oil serv...
1 CitationsSource
#1Zhuan Liao ('SMMU': Second Military Medical University)H-Index: 19
#2Liang-Hao Hu ('SMMU': Second Military Medical University)H-Index: 17
Last. Zhao-Shen Li ('SMMU': Second Military Medical University)H-Index: 59
view all 4 authors...
Background ERCP had been performed throughout China for decades. Objective To determine the status of ERCP service in China. Design A national survey. Setting All of the hospitals performing ERCP in mainland China in 2006. Patients All of the patients undergoing ERCP in mainland China in 2006. Main Outcome Measurements The questionnaire included the (1) type of hospitals involved; (2) ownership of the endoscopy unit; (3) ERCP infrastructure; (4) volume, indication, setting, and anesthesia method...
12 CitationsSource
#1Milan S. Bassan (Westmead Hospital)H-Index: 8
#1Alberto Mariani (UniSR: Vita-Salute San Raffaele University)H-Index: 27
Last. Pier Alberto Testoni (UniSR: Vita-Salute San Raffaele University)H-Index: 39
view all 5 authors...
Background Guidewire (GW) cannulation can reduce the risk of post-ERCP pancreatitis (PEP) by avoiding the opacification of the main pancreatic duct. Objective To compare the effects of conventional contrast ERCP and GW cannulation of the common bile duct on the rate of PEP in low- and high-risk patients. Design Prospective, comparative-intervention single-center study. Setting Tertiary referral center. Patients Patients with biliary disease with an intact papilla were prospectively examined by E...
54 CitationsSource
#1Pier Alberto Testoni (UniSR: Vita-Salute San Raffaele University)H-Index: 39
#2A. Giussani (UniSR: Vita-Salute San Raffaele University)H-Index: 9
Last. Alberto Mariani (UniSR: Vita-Salute San Raffaele University)H-Index: 27
view all 6 authors...
Abstract Background Repeated attempts at cannulating the papilla of Vater and “needle-knife” precut sphincterotomy are independent risk factors for post-ERCP pancreatitis. Whether precut alone or repeated attempts at cannulation is the culprit factor in the development of post-ERCP pancreatitis remains controversial. Aim To retrospectively assess the role of precutting and multiple cannulation in the occurrence of post-ERCP pancreatitis in a consecutive series of patients with bile stone disease...
32 CitationsSource
#1Qiang Cai (Emory University)H-Index: 16
#2Steve KeilinH-Index: 1
Last. Yan Li (Emory University)H-Index: 1
view all 4 authors...
Intraduodenal Hydrochloric Acid Infusion for Facilitation of Cannulation of the Dorsal Pancreatic Duct at ERCP in Patients With Pancreas Divisum: A Preliminary Study
5 CitationsSource
Cited By4
Abstract Background We aimed to assess factors impacting the endoscopic minor papilla sphincterotomy (EMPS) success rate, clinical efficacy, and safety in a large cohort of patients with symptomatic pancreas divisum (PD). Methods Retrospective study including patients with PD referred to the Pancreas Institute of Verona from May 2009 to May 2020 to undergo EMPS. The whole population was analyzed to assess EMPS technical success, defined as the rate of deep cannulation of the dorsal duct. Patient...
#1Zhu Congyuan (Jiangnan University)
#2Jianping Li (Jiangnan University)
Last. Jingqiu Sun (Jiangnan University)
view all 6 authors...
In this study, we aimed to evaluate the suppressive abilities of berberine (BBR) on MCF-7 and MDA-MB-231 cells and confirm its underlying mechanisms on miR-214-3p. We first built a panel of 18 miRNAs and 9 lncRNAs that were reported to participate in the mechanism of breast cancer. The RT-qPCR results suggested that BBR illustrated a dosage-dependent pattern in the stimulation to miR-214-3p in both MCF-7 and MDA-MB-231 cells. Then, we performed gain-and-lose function tests to validate the role o...
#1Kemmian D. Johnson (LSU: Louisiana State University)H-Index: 3
#1Kemmian D Johnson (LSU: Louisiana State University)H-Index: 2
Last. Sumant Inamdar (University of Arkansas for Medical Sciences)H-Index: 16
view all 7 authors...
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perfor...
3 CitationsSource
#1Murat Pekgöz (Medical Park)H-Index: 1
#1Murat Pekgöz (Medical Park)H-Index: 1
BACKGROUND: Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.AIMSTo study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS: A systematic literature review on the preven...
9 CitationsSource