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Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results.
Gastrointest Endosc 2008; 67(2):255-61GE

Abstract

BACKGROUND

Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication.

OBJECTIVE

Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population.

DESIGN

Non-randomized, retrospective study.

SETTING

Large, tertiary referral center.

PATIENTS

From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated.

INTERVENTIONS

PD stent placement.

MAIN OUTCOME MEASUREMENT

Pancreatitis rates.

RESULTS

A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P= .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P< .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P= .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy.

LIMITATIONS

Nonrandomized, retrospective design.

CONCLUSION

Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.

Authors+Show Affiliations

Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18028920

Citation

Saad, Abdo M., et al. "Pancreatic Duct Stent Placement Prevents post-ERCP Pancreatitis in Patients With Suspected Sphincter of Oddi Dysfunction but Normal Manometry Results." Gastrointestinal Endoscopy, vol. 67, no. 2, 2008, pp. 255-61.
Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results. Gastrointest Endosc. 2008;67(2):255-61.
Saad, A. M., Fogel, E. L., McHenry, L., Watkins, J. L., Sherman, S., Lazzell-Pannell, L., & Lehman, G. A. (2008). Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results. Gastrointestinal Endoscopy, 67(2), pp. 255-61.
Saad AM, et al. Pancreatic Duct Stent Placement Prevents post-ERCP Pancreatitis in Patients With Suspected Sphincter of Oddi Dysfunction but Normal Manometry Results. Gastrointest Endosc. 2008;67(2):255-61. PubMed PMID: 18028920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results. AU - Saad,Abdo M, AU - Fogel,Evan L, AU - McHenry,Lee, AU - Watkins,James L, AU - Sherman,Stuart, AU - Lazzell-Pannell,Laura, AU - Lehman,Glen A, Y1 - 2007/10/29/ PY - 2007/03/29/received PY - 2007/06/13/accepted PY - 2007/11/22/pubmed PY - 2008/4/5/medline PY - 2007/11/22/entrez SP - 255 EP - 61 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 67 IS - 2 N2 - BACKGROUND: Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. OBJECTIVE: Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population. DESIGN: Non-randomized, retrospective study. SETTING: Large, tertiary referral center. PATIENTS: From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. INTERVENTIONS: PD stent placement. MAIN OUTCOME MEASUREMENT: Pancreatitis rates. RESULTS: A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P= .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P< .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P= .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy. LIMITATIONS: Nonrandomized, retrospective design. CONCLUSION: Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/18028920/Pancreatic_duct_stent_placement_prevents_post_ERCP_pancreatitis_in_patients_with_suspected_sphincter_of_Oddi_dysfunction_but_normal_manometry_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)02147-5 DB - PRIME DP - Unbound Medicine ER -