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Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis.
Dig Endosc 2009; 21(1):8-13DE

Abstract

INTRODUCTION

The aim of the present study was to reduce post-endoscopic retrograde cholangiopancreatography (ERCP) complications with a combination of early needle-knife access fistulotomy and prophylactic pancreatic stenting in selected high-risk sphincter of Oddi dysfunction (SOD) patients with difficult cannulation.

METHODS

Prophylactic pancreatic stent insertion was attempted in 22 consecutive patients with definite SOD and difficult cannulation. After 10 min of failed selective common bile duct cannulation, but repeated (>5x) pancreatic duct contrast filling, a prophylactic small calibre (3-5 Fr) pancreatic stent was inserted, followed by fistulotomy with a standard needle-knife, then a standard complete biliary sphincterotomy followed. The success and complication rates were compared retrospectively with a cohort of 35 patients, in which we persisted with the application of standard methods of cannulation without pre-cutting methods.

RESULTS

Prophylactic pancreatic stenting followed by needle-knife fistulotomy was successfully carried out in all 22 consecutive patients, and selective biliary cannulation and complete endoscopic sphincterotomy were achieved in all but two cases. In this group, not a single case of post-ERCP pancreatitis was observed, in contrast with a control group of three mild, 10 moderate and two severe post-ERCP pancreatitis cases. The frequency of post-ERCP pancreatitis was significantly different: 0% versus 43%, as were the post-procedure (24 h mean) amylase levels: 206 U/L versus 1959 U/L, respectively.

CONCLUSIONS

In selected, high-risk, SOD patients, early, prophylactic pancreas stent insertion followed by needle-knife fistulotomy seems a safe and effective procedure with no or only minimal risk of post-ERCP pancreatitis. However, prospective, randomized studies are awaited to lend to support to our approach.

Authors+Show Affiliations

First Department of Internal Medicine, Fejér Megyei Szent György Hospital, Székesfehérvár, Hungary. lmadacsy@mail.fmkorhaz.huNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19691794

Citation

Madácsy, László, et al. "Prophylactic Pancreas Stenting Followed By Needle-knife Fistulotomy in Patients With Sphincter of Oddi Dysfunction and Difficult Cannulation: New Method to Prevent post-ERCP Pancreatitis." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 21, no. 1, 2009, pp. 8-13.
Madácsy L, Kurucsai G, Fejes R, et al. Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis. Dig Endosc. 2009;21(1):8-13.
Madácsy, L., Kurucsai, G., Fejes, R., Székely, A., & Székely, I. (2009). Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 21(1), pp. 8-13. doi:10.1111/j.1443-1661.2008.00819.x.
Madácsy L, et al. Prophylactic Pancreas Stenting Followed By Needle-knife Fistulotomy in Patients With Sphincter of Oddi Dysfunction and Difficult Cannulation: New Method to Prevent post-ERCP Pancreatitis. Dig Endosc. 2009;21(1):8-13. PubMed PMID: 19691794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis. AU - Madácsy,László, AU - Kurucsai,Gábor, AU - Fejes,Roland, AU - Székely,András, AU - Székely,Iván, PY - 2009/8/21/entrez PY - 2009/8/21/pubmed PY - 2009/11/11/medline SP - 8 EP - 13 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 21 IS - 1 N2 - INTRODUCTION: The aim of the present study was to reduce post-endoscopic retrograde cholangiopancreatography (ERCP) complications with a combination of early needle-knife access fistulotomy and prophylactic pancreatic stenting in selected high-risk sphincter of Oddi dysfunction (SOD) patients with difficult cannulation. METHODS: Prophylactic pancreatic stent insertion was attempted in 22 consecutive patients with definite SOD and difficult cannulation. After 10 min of failed selective common bile duct cannulation, but repeated (>5x) pancreatic duct contrast filling, a prophylactic small calibre (3-5 Fr) pancreatic stent was inserted, followed by fistulotomy with a standard needle-knife, then a standard complete biliary sphincterotomy followed. The success and complication rates were compared retrospectively with a cohort of 35 patients, in which we persisted with the application of standard methods of cannulation without pre-cutting methods. RESULTS: Prophylactic pancreatic stenting followed by needle-knife fistulotomy was successfully carried out in all 22 consecutive patients, and selective biliary cannulation and complete endoscopic sphincterotomy were achieved in all but two cases. In this group, not a single case of post-ERCP pancreatitis was observed, in contrast with a control group of three mild, 10 moderate and two severe post-ERCP pancreatitis cases. The frequency of post-ERCP pancreatitis was significantly different: 0% versus 43%, as were the post-procedure (24 h mean) amylase levels: 206 U/L versus 1959 U/L, respectively. CONCLUSIONS: In selected, high-risk, SOD patients, early, prophylactic pancreas stent insertion followed by needle-knife fistulotomy seems a safe and effective procedure with no or only minimal risk of post-ERCP pancreatitis. However, prospective, randomized studies are awaited to lend to support to our approach. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/19691794/Prophylactic_pancreas_stenting_followed_by_needle_knife_fistulotomy_in_patients_with_sphincter_of_Oddi_dysfunction_and_difficult_cannulation:_new_method_to_prevent_post_ERCP_pancreatitis_ L2 - https://doi.org/10.1111/j.1443-1661.2008.00819.x DB - PRIME DP - Unbound Medicine ER -