Author’s reply to Dr Kadayifci

Author’s reply to Dr Kadayifci

Dr. Kadayifci raises two interesting points. Firstly, as he correctly points out, wire-guided cannulation has been reported to reduce the risk of post-ERCP pancreatitis (PEP). As authors, we were interested in this aspect of practice and its influence on outcome. However at the design stage of the study it became apparent that inclusion of every variable of interest would result in a questionnaire of prohibitive length and an analysis that would be ”overfitted”. As a result, endoscopists were not asked to list all the devices used to attempt cannulation, and although acquisition of a cholangiogram was the norm, we are not able to quantify how many cannulations were initially performed with a wire rather than a catheter. We agree with Dr Kadayifci that this is an area of practice that merits further examination.

Similarly we were constrained in the amount of information we could collect regarding patients’ past medical histories, and restricted our focus to ASA score, past hepatobiliary surgery, the presence of cirrhosis, ongoing hemodialysis, and anticoagulation therapy. Obesity, defined as a BMI > 30, was also recorded, and in post hoc analysis did not appear to influence the incidence of PEP. However we did not ask endoscopists to record whether patients were diabetic. The hypothesis that diabetes is a risk factor for (more severe) PEP is, to our knowledge, a novel one and we therefore look forward to the results of Dr Kadayifci’s current work in this area.

Competing interests: None