P2278 - Selective Common Bile Duct Cannulation Time During Endoscopic Retrograde Cholangiopancreatography: Effects of Dexamethasone

Award: Outstanding Research Award in the Interventional Endoscopy Category (Trainee)

Award: Presidential Poster Award

Muhammad Nabeel Shafqat, MD¹, Najam-us-Sehar Saeed, MBBS, FCPS², Salman Javed, MBBS, FCPS³, Muhammad Adil, MBBS⁴, Ghania Shafqat, MBBS, FCPS⁵, Fatima Akram, MBBS, FCPS⁵, Miqdad Haider, MD⁶, Auj Chaudhry, MBBS¹, Sohail Khan, BSc⁷, Faizan Zahoor, MBBS, FCPS^1
1District Headquarter Hospital Gujranwala, Gujranwala, Punjab, Pakistan; ²Gujranwala Medical College, Gujranwala, Punjab, Pakistan; ³Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ⁴District Headquarter Hospital-Gujranwala Medical College, Gujranwala, Punjab, Pakistan; ⁵Shalamar Institute of Health Sciences, Lahore, Punjab, Pakistan; ⁶Heartlands Hospital, Birmingham, England, United Kingdom; ⁷Instituite of Business and Information Technology, University of Punjab, Lahore, Punjab, Pakistan

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is the most important diagnostic and therapeutic tool for pancreato-biliary pathologies. Common bile duct (CBD) cannulation is a challenging step and cannulation time has been considered as an accurate measure of procedure difficulty. Various agents have been studied in an attempt to shorten the CBD cannulation time and reduce the risk of complications. Steroids are potent anti-inflammatory agents and smooth muscle relaxants. The objective of this study was to determine the effects of dexamethasone on shortening of deep CBD cannulation time during ERCP.

Methods: In this randomized double blinded clinical trial, a total of 80 patients requiring ERCP were included and randomized into two groups, experimental and control, using random permuted block technique. Experimental group received 8mg (2cc) of dexamethasone 2-4 hours before ERCP, while the control group was given 2cc of normal saline (placebo). During ERCP procedures, CBD cannulation time, number of cannulation attempts, fluoroscopy time and total ERCP duration were calculated. Student’s t-test and Wilcoxon sign rank test were used for data analysis and comparison between groups.

Results: The results showed a significant difference of 9.83 minutes (P=0.011) in the mean CBD cannulation time in dexamethasone treated group (7.14 minutes) when compared with control group (16.97 minutes). The total number of CBD cannulation attempts were significantly lower in the treatment group as opposed to control group, at 6.23 attempts vs. 9.43 attempts (P=0.002). Compared with normal saline group, in dexamethasone group the mean total fluoroscopy time was shorter, at 2.03 minutes vs. 5.53 minutes (P=0.001). The mean total procedure time was noticed to reduce from 44.25 minutes in control group to 29.18 minutes in the dexamethasone group (P=0.001). No immediate or long term complications were observed.

Discussion: Prolonged blind cannulation may cause local trauma, bleeding, sphincter of oddi spasm and post ERCP pancreatitis. The administration of dexamethasone reduced CBD cannulation time and the number of attempts, resulting in more efficient procedure with overall reduction in morbidity. Total fluoroscopy time was reduced with the use of dexamethasone which led to decrease in radiation exposure to patients and staff. Further large scale multicenter prospective randomized trials are required to evaluate the role of dexamethasone on CBD cannulation time during ERCP.


Disclosures:


Muhammad Nabeel Shafqat, MD¹, Najam-us-Sehar Saeed, MBBS, FCPS², Salman Javed, MBBS, FCPS³, Muhammad Adil, MBBS⁴, Ghania Shafqat, MBBS, FCPS⁵, Fatima Akram, MBBS, FCPS⁵, Miqdad Haider, MD⁶, Auj Chaudhry, MBBS¹, Sohail Khan, BSc⁷, Faizan Zahoor, MBBS, FCPS¹. P2278 - Selective Common Bile Duct Cannulation Time During Endoscopic Retrograde Cholangiopancreatography: Effects of Dexamethasone, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.