{"id":21751,"date":"2026-08-11T07:00:00","date_gmt":"2026-08-11T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=21751"},"modified":"2026-08-11T03:29:40","modified_gmt":"2026-08-11T03:29:40","slug":"canulacao-pancreatica-pancreatite-pos-cpre","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/canulacao-pancreatica-pancreatite-pos-cpre\/","title":{"rendered":"Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data"},"content":{"rendered":"\n

Publicado na Endoscopy em fevereiro de 2026<\/a><\/p>\n\n\n\n

Autores: Gupta M, Chau M, Howarth M, Cartwright S, Ficaccio S, Tepox-Padron A, Alshammari Y, Guo H, Chen YI, Singh A, Hookey L, Arya N, Causada Calo N, Grover SC, Chatterjee A, Siersema PD, Thosani NC, Heitman SJ, Lei Y, Li S, Meng ZW, Mohamed R, Turbide C, Elmunzer BJ, Forbes N.<\/p>\n\n\n\n


Introdu\u00e7\u00e3o<\/strong><\/h2>\n\n\n\n


A canula\u00e7\u00e3o do ducto pancre\u00e1tico \u00e9 um fator de risco de pancreatite aguda p\u00f3s-CPRE (1, 2). Apesar de alguns estudos mostrarem que apenas um acesso ao ducto pancre\u00e1tico principal (DPP) n\u00e3o est\u00e1 associado ao risco de PEP (3, 4), este achado n\u00e3o se replicou em outros trabalhos (1, 2). Desse modo, n\u00e3o se sabe o impacto real do (I) n\u00famero de canula\u00e7\u00f5es do DPP<\/strong>, (II) sua<\/strong> profundidade<\/strong> e (III) acesso a ductos secund\u00e1rios<\/strong>. Assim, desenhou-se este estudo para investigar esta lacuna da literatura.<\/p>\n\n\n\n


M\u00e9todos<\/strong><\/h2>\n\n\n\n

Trata-se de um estudo prospectivo observacional, envolvendo nove centros nos Estados Unidos, Canad\u00e1 e Europa. Um observador treinado era respons\u00e1vel por obter os dados do procedimento e do paciente. Al\u00e9m disso, avalia\u00e7\u00e3o de PEP foi realizada por investigadores cegos aos dados do procedimento.<\/p>\n\n\n\n

Foram inclu\u00eddos pacientes submetidos \u00e0 CPRE com interven\u00e7\u00e3o direcionada para a via biliar.<\/p>\n\n\n\n

O uso de anti-inflamat\u00f3rio via retal, hiper-hidrata\u00e7\u00e3o com ringer lactato e stents pancre\u00e1ticos foi deixado a crit\u00e9rio do m\u00e9dico executor do procedimento e computado entre os dados do procedimento.<\/p>\n\n\n\n

Foram avaliados: n\u00famero de canula\u00e7\u00f5es do DPP (nenhuma, uma ou m\u00faltiplas), profundidade (cabe\u00e7a ou corpo\/cauda) e canula\u00e7\u00e3o de ductos secund\u00e1rios.<\/p>\n\n\n\n

\n
\"Canula\u00e7\u00e3o<\/a>
Pr\u00f3tese pancre\u00e1tica tipo single pigtail transpapilar<\/figcaption><\/figure>\n\n\n\n
\"Canula\u00e7\u00e3o<\/a>
Cateteriza\u00e7\u00e3o do ducto pancre\u00e1tico principal<\/figcaption><\/figure>\n<\/figure>\n\n\n\n


Resultados<\/strong><\/h2>\n\n\n\n

Foram recrutados 7430 pacientes entre 2021 e 2024. Destes pacientes, 1508 (20,3%) tiveram canula\u00e7\u00e3o do DPP. A taxa de PEP foi de 3,8% (282 pacientes) no total e 5,1% (217\/4268 pacientes) nos submetidos \u00e0 CPRE pela 1a<\/sup> vez.<\/p>\n\n\n\n

Os resultados s\u00e3o subdivididos em 3 itens, com a respectiva tabela original do trabalho:<\/p>\n\n\n\n

1. Canula\u00e7\u00e3o \u00fanica do DPP e chance de PEP no total de pacientes<\/strong><\/h3>\n\n\n\n

Fatores de risco relacionados com PEP na an\u00e1lise multivariada: canula\u00e7\u00e3o do DPP (sem diferen\u00e7a entre uma ou mais vezes), pacientes mais novos, sexo feminino, tempo do procedimento e n\u00famero de tentativas maiores. O uso de AINE via retal e de stent pancre\u00e1ticos se mostrou como fator protetor.<\/strong><\/p>\n\n\n

\n
\"\"<\/a>

Tabela (artigo original): modelo de regress\u00e3o identificando as associa\u00e7\u00f5es entre vari\u00e1veis do paciente e da CPRE no total de pacientes submetidos ao procedimento.<\/figcaption><\/figure>\n<\/div>\n\n\n

2. Canula\u00e7\u00e3o \u00fanica do DPP e chance de PEP em pacientes submetidos \u00e0 CPRE pela 1<\/strong>a<\/strong><\/sup> vez<\/strong><\/h3>\n\n\n\n

Nestes 4268 pacientes, 217 tiveram PEP (5,1%).<\/p>\n\n\n\n

A canula\u00e7\u00e3o do DPP aumentou a chance de PEP, por\u00e9m sem diferen\u00e7a entre uma ou mais canula\u00e7\u00f5es<\/strong>. O stent pancre\u00e1tico est\u00e1 associado a menor taxa de PEP, enquanto que o uso de AINE retal e hidrata\u00e7\u00e3o n\u00e3o se mostraram como fatores protetores. Assim como na casu\u00edstica total, idade menor, maior tempo de procedimento e maior n\u00famero de tentativas de canula\u00e7\u00e3o foram fatores de risco para PEP.<\/p>\n\n\n

\n
\"\"<\/a>

Tabela (artigo original): modelo de regress\u00e3o identificando as associa\u00e7\u00f5es entre vari\u00e1veis do paciente e da CPRE nos pacientes submetidos \u00e0 CPRE pela 1a<\/sup> vez.<\/figcaption><\/figure>\n<\/div>\n\n
\n
\"\"<\/a>

Figura (artigo original): rela\u00e7\u00e3o entre o n\u00famero de canula\u00e7\u00f5es do DPP e a chance de PEP, em compara\u00e7\u00e3o aos casos sem cateteriza\u00e7\u00e3o do DPP. a) todos os paciente b) Paciente realizando CPRE pela primeira vez<\/figcaption><\/figure>\n<\/div>\n\n\n

3. Chance de PEP segundo profundidade e canula\u00e7\u00e3o de ductos secund\u00e1rios no total de pacientes submetidos \u00e0 CPRE<\/strong><\/h3>\n\n\n\n

Tanto a progress\u00e3o do fio guia restrita \u00e0 cabe\u00e7a, quanto at\u00e9 corpo\/cauda estiveram associados a PEP, por\u00e9m sem diferen\u00e7a entre eles. Al\u00e9m disso, a cateteriza\u00e7\u00e3o de ductos secund\u00e1rios n\u00e3o se mostrou relacionado \u00e0 PEP.<\/strong><\/p>\n\n\n

\n
\"Canula\u00e7\u00e3o<\/a>

Tabela (artigo original): modelo de regress\u00e3o para identificar a associa\u00e7\u00e3o entre profundidade e canula\u00e7\u00e3o de ductos secund\u00e1rios durante a CPRE no total de pacientes submetidos ao procedimento.<\/figcaption><\/figure>\n<\/div>\n\n\n


Discuss\u00e3o<\/strong><\/h2>\n\n\n\n

A canula\u00e7\u00e3o do DPP sempre foi motivo de preocupa\u00e7\u00e3o devido \u00e0 sua rela\u00e7\u00e3o com a pancreatite. Nesse sentido, este estudo buscou preencher uma lacuna na literatura sobre canula\u00e7\u00e3o pancre\u00e1tica e pancreatite p\u00f3s-CPRE, envolvendo quest\u00f5es quantitativas (n\u00famero de canula\u00e7\u00f5es) e qualitativas (profundidade e acesso a ductos secund\u00e1rios).<\/p>\n\n\n\n

O primeiro resultado interessante \u00e9 que apenas uma canula\u00e7\u00e3o do DPP j\u00e1 se mostrou como risco para PEP, n\u00e3o havendo evidente aumento de risco (de PEP) com mais acessos ao DPP. Desse modo, os autores colocam a possibilidade de um uso mais frequente de stent pancre\u00e1tico, mesmo apenas com um acesso ao DPP<\/strong>. Esta op\u00e7\u00e3o terap\u00eautica \u00e9 refor\u00e7ada por um estudo randomizado pr\u00e9vio que mostrou benef\u00edcio em associar o stent pancre\u00e1tico ao uso de AINE retal (5).<\/p>\n\n\n\n

Por outro lado, a t\u00e9cnica do duplo fio guia n\u00e3o esteve associada \u00e0 PEP<\/strong>. Poss\u00edveis explica\u00e7\u00f5es seriam (I) menor tempo e trauma de canula\u00e7\u00e3o pelo acesso mais r\u00e1pido \u00e0 via biliar ou (II) menor n\u00famero de pacientes, n\u00e3o demonstrando a maior incid\u00eancia de PEP. Para entusiastas da t\u00e9cnica, fica a mensagem de sua utiliza\u00e7\u00e3o precoce e poss\u00edvel associa\u00e7\u00e3o com stent pancre\u00e1tico com maior frequ\u00eancia.<\/p>\n\n\n\n

Como resultados finais, a profundidade do acesso ao DPP e a cateteriza\u00e7\u00e3o de ductos secund\u00e1rios n\u00e3o aumentaram o risco de PEP. Quest\u00f5es como tempo em que o fio guia permanece no DPP e calibre do fio n\u00e3o foram abordadas.<\/p>\n\n\n\n

Portanto, trata-se de um estudo muito bem desenhado para a an\u00e1lise alvo, que evidenciou o aumento do risco de PEP para qualquer n\u00famero de acessos ao DPP<\/strong>, refor\u00e7ando que o uso mais frequente de stents pancre\u00e1ticos pode ajudar a diminuir tal complica\u00e7\u00e3o.<\/strong><\/p>\n\n\n\n


Refer\u00eancias<\/strong><\/h2>\n\n\n\n
    \n
  1. Fujita K, Yazumi S, Matsumoto H, Asada M, Nebiki H, Matsumoto K, et al; Bilio-pancreatic Study Group of West Japan. Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc. 2022;34(6):1198-1204. <\/li>\n\n\n\n
  2. Nakai Y, Isayama H, Sasahira N, Kogure H, Sasaki T, Yamamoto N, et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc. 2015;81(1):119-126. <\/li>\n\n\n\n
  3. Shin SH, So H, Cho S, Kim N, Baik GH, Lee SK, et al. The number of wire placement in the pancreatic duct and metal biliary stent as risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol. 2020;35(7):1201-1207. <\/li>\n\n\n\n
  4. Goenka MK, Akshintala VS, Kamal A, Bhullar FA, Bush N, Kumar V, et al. Frequent guidewire passage into the pancreatic duct is an independent risk factor for postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) among high-risk individuals: a post-hoc analysis of a randomized controlled trial data. J Dig Dis. 2023;24(6-7):427-433. <\/li>\n\n\n\n
  5. Elmunzer BJ, Foster LD, Serrano J, Cot\u00e9 GA, Edmundowicz SA, Wani S, et al; SVI Study Group. Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial. Lancet. 2024;403(10425):450-458<\/li>\n<\/ol>\n\n\n\n

    Como citar este artigo<\/strong><\/h2>\n\n\n\n

    Funari MP. Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data. Endoscopia Terapeutica 2026 Vol II. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/number-depth-and-location-of-inadvertent-pancreatic-guidewire-cannulations-and-their-association-with-post-ercp-pancreatitis-multicenter-real-time-intra-procedural-data\/<\/a><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Publicado na Endoscopy em fevereiro de 2026 Autores: Gupta M, Chau M, Howarth M,…<\/p>\n","protected":false},"author":3493,"featured_media":21762,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[142],"tags":[294,460,882],"ano":[847],"tipo":[791,155],"volume":[147],"class_list":["post-21751","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigoscomentados","tag-cpre","tag-pancreatite","tag-pep","ano-847","tipo-artigos-comentados","tipo-cpre","volume-volume-ii"],"yoast_head":"\nCanula\u00e7\u00e3o Pancre\u00e1tica e Pancreatite P\u00f3s-CPRE<\/title>\n<meta name=\"description\" content=\"Canula\u00e7\u00e3o pancre\u00e1tica e pancreatite p\u00f3s-CPRE: estudo avalia se n\u00famero, profundidade e local de canula\u00e7\u00e3o do DPP elevam o risco de PEP\" \/>\n<meta name=\"robots\" content=\"index, follow, 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