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Rendezvous Cannulation Technique Reduces Post-ERCP Pancreatitis: A Prospective Nationwide Study of 12,718 ERCP Procedures

Swahn, Fredrik MD, PhD1; Nilsson, Magnus MD, PhD1; Arnelo, Urban MD, PhD1; Löhr, Matthias MD, PhD1; Persson, Gunnar MD, PhD2; Enochsson, Lars MD, PhD1

American Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 552–559
doi: 10.1038/ajg.2012.470

OBJECTIVES: The aim of this study was to investigate if intraoperative rendezvous cannulation reduces the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) because there is no universal consensus on the optimal treatment of common bile duct stones.

METHODS: We performed a nationwide case–control study, nested within the cohort of ERCP procedures reported to the Swedish Registry for Gallstone Surgery and ERCP (GallRiks), between 2007 and 2009. Data were collected prospectively from a web-based registry of ERCP procedures that includes variables such as patient characteristics, indication, cannulation technique, diagnostic findings, therapeutic measures, and complications. The primary outcome was PEP.

RESULTS: The registry included 12,718 ERCP procedures performed on patients without a history of previous ERCP. The risk of PEP when using the rendezvous technique compared with those who were cannulated by conventional means was reduced from 3.6 to 2.2% (odds ratio (OR) 0.5, 95% confidence interval 0.2–0.9,P=0.02). Although a significant reduction there are overall relatively few cases with PEP and the calculated numbers needed to treat to avoid one case of PEP is as high as 71. Other factors associated with increased risk of PEP were young age, prolonged procedure time, and elective ERCP.

CONCLUSIONS: Rendezvous bile duct cannulation during ERCP reduces the risk of PEP from 3.6 to 2.2% compared with conventional biliary cannulation.

1 Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden

2 Department of Surgery, Ryhov Hospital, Jönköping, Sweden

Correspondence: Fredrik Swahn, MD, PhD, Department of Surgical Gastroenterology, Karolinska University Hospitalm, S-141 86 Stockholm, Sweden. E-mail:

Received 17 August 2012; accepted 4 December 2012

published online 19 February 2013

© The American College of Gastroenterology 2013. All Rights Reserved.
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