Cooling the papilla with ice water in preventing post-ERCP pancreatitis (ice water challenge study)

Background The most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). The aim of this study was to investigate the efficacy of cooling the papilla with iced water to reduce PEP. Patients and methods Between December 2018 and July 2019, 100 consecutive patients with native papilla undergoing ERCP were prospectively enrolled in this study. In all patients, iced water was injected endoscopically toward the papilla via the working channel at the end of ERCP. The results were compared with 100 previous cases with native papilla that underwent ERCP under the same conditions without papilla cooling. Results Although the difference was not significant, the incidence of PEP tended to be lower in the study group (4%) than in the control group (11%) ( p = 0.060). In addition, the incidence of PEP was significantly reduced in patients who underwent biliary sphincterotomy ( p = 0.033). All cases of PEP were mild. Conclusions Cooling the papilla with iced water injection, which is safe, easy, and cheap might reduce PEP.