Effect of ice water injection toward the duodenal papilla for preventing post-ERCP pancreatitis: study protocol for a multicenter, single-blinded, randomized controlled trial (EUTOPIA study)

Shunjiro Azuma; Akira Kurita; Kenichi Yoshimura; Tomoaki Matsumori; Yosuke Kobayashi; Kei Yane; Osamu Inatomi; Kenji Sawada; Ryo Harada; Shujiro Yazumi

doi:10.1186/s12876-022-02462-z

Effect of ice water injection toward the duodenal papilla for preventing post-ERCP pancreatitis: study protocol for a multicenter, single-blinded, randomized controlled trial (EUTOPIA study)

BMC Gastroenterol. 2022 Aug 12;22(1):382. doi: 10.1186/s12876-022-02462-z.

Authors

Shunjiro Azuma^#¹, Akira Kurita^#^{2

3}, Kenichi Yoshimura⁴, Tomoaki Matsumori⁵, Yosuke Kobayashi⁶, Kei Yane⁷, Osamu Inatomi⁸, Kenji Sawada⁹, Ryo Harada¹⁰, Shujiro Yazumi¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
² Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan. kuritaaki1976@gmail.com.
³ Department of Gastroenterology and Hepatology, Rakuwakai Otowa Hospital, 2 Otowachinjicho Yamashina-ku, Kyoto, 607-8062, Japan. kuritaaki1976@gmail.com.
⁴ Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan.
⁵ Department of Gastroenterology and Hepatology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
⁶ Department of Gastroenterology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka, 430-8558, Japan.
⁷ Department of Gastroenterology and Hepatology, Tonan Hospital, 3-8, 7-3, Kita 4-jo Nishi, Chuo-ku, Sapporo-shi, Hokkaido, 060-0004, Japan.
⁸ Department of Gastroenterology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu city, Shiga, 520-2192, Japan.
⁹ Department of Gastroenterology and Hepatology, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan.
¹⁰ Department of Gastroenterology and Hepatology, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama City, Okayama, 700-8607, Japan.

^# Contributed equally.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure in the diagnosis and treatment of biliopancreatic diseases. The most common adverse event of ERCP is post-ERCP pancreatitis (PEP), which can sometimes be severe. Our previous study suggested that injecting ice water at the end of ERCP suppressed PEP, and we decided to investigate this effect in a multicenter randomized controlled trial.

Methods: This study is being conducted at eight hospitals in Japan starting in April 2022. Patients undergoing ERCP will be randomized to ice water group and control group. In the ice water group, 250 ml of ice water is injected toward the papilla at the end of ERCP. The next morning, a physical examination and blood tests are performed to evaluate for the development of pancreatitis. The goal is to have 440 cases in each group.

Discussion: The main cause of PEP is thought to be papilla edema. Cooling the papilla, as everyone naturally does at the time of a burn, is expected to prevent its inflammation and edema. Various methods to suppress PEP have been reported, but so far none of them are reliable. The method we have devised is very simple, easy, and safe. We hope that our study will change the world's ERCP common practice.

Trial registration: UMIN000047528. Registered 20 April 2022, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053209.

Keywords: ERCP; Ice water; PEP; Post-ERCP pancreatitis.

Publication types

Clinical Trial Protocol

MeSH terms

Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
Duodenum
Humans
Japan
Multicenter Studies as Topic
Pancreatitis* / diagnosis
Pancreatitis* / etiology
Pancreatitis* / prevention & control
Randomized Controlled Trials as Topic
Water

Substances

Water