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Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study.
Gastrointest Endosc 2012; 76(3):578-85GE

Abstract

BACKGROUND

Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCP. Difficult biliary cannulation can be a procedure-related risk factor for PEP. Recent studies reported that a prophylactic pancreatic stent (PS) can reduce the frequency and severity of PEP.

OBJECTIVE

To evaluate the efficacy and usefulness of a temporary 3F PS to prevent PEP in patients with difficult biliary cannulations.

DESIGN

A multicenter, prospective, randomized study.

SETTING

Two tertiary-care academic medical centers.

PATIENTS

In total, 101 patients with a difficult biliary cannulation were randomly divided into the 3F PS placement group (PS group, n = 50) or the nonstent (NS) group (NS group, n = 51).

INTERVENTIONS

Endoscopic placement of a 3F unflanged PS.

MAIN OUTCOME MEASUREMENTS

The incidence and severity of PEP in the 2 groups, spontaneous dislodgment of stents, and procedure-related complications.

RESULTS

The technical success rate of 3F PS placement was 96% (48/50). The lengths of the stents were 4 cm (n = 21), 6 cm (n = 15), and 8 cm (n = 12). Spontaneous stent dislodgment within 7 days occurred in 94% of patients (45/48). The mean duration until spontaneous dislodgment was 3.5 days. The incidence rate of PEP was 12% (6/50: mild, 5; moderate, 1) in the PS group and 29.4% (15/51: mild, 12; moderate, 2; severe, 1) in the NS group. Severe pancreatitis occurred in only 1 patient in the NS group. In a multivariate analysis, prophylactic placement of PS was the only prophylactic factor for PEP (odds ratio, 0.126; 95% CI, 0.025-0.632, P = .012).

LIMITATIONS

No comparative results for stent size and diameter and a low-risk cohort group.

CONCLUSIONS

Prophylactic temporary 3F PS placement in patients with a difficult biliary cannulation during ERCP seems to be a safe and effective method for reducing PEP and results in a high rate of spontaneous passage of stents without complications.

Authors+Show Affiliations

Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Cheonan, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

22771100

Citation

Lee, Tae Hoon, et al. "Prophylactic Temporary 3F Pancreatic Duct Stent to Prevent post-ERCP Pancreatitis in Patients With a Difficult Biliary Cannulation: a Multicenter, Prospective, Randomized Study." Gastrointestinal Endoscopy, vol. 76, no. 3, 2012, pp. 578-85.
Lee TH, Moon JH, Choi HJ, et al. Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study. Gastrointest Endosc. 2012;76(3):578-85.
Lee, T. H., Moon, J. H., Choi, H. J., Han, S. H., Cheon, Y. K., Cho, Y. D., ... Kim, S. J. (2012). Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study. Gastrointestinal Endoscopy, 76(3), pp. 578-85. doi:10.1016/j.gie.2012.05.001.
Lee TH, et al. Prophylactic Temporary 3F Pancreatic Duct Stent to Prevent post-ERCP Pancreatitis in Patients With a Difficult Biliary Cannulation: a Multicenter, Prospective, Randomized Study. Gastrointest Endosc. 2012;76(3):578-85. PubMed PMID: 22771100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study. AU - Lee,Tae Hoon, AU - Moon,Jong Ho, AU - Choi,Hyun Jong, AU - Han,Seung Hyo, AU - Cheon,Young Koog, AU - Cho,Young Deok, AU - Park,Sang-Heum, AU - Kim,Sun-Joo, Y1 - 2012/07/07/ PY - 2011/09/30/received PY - 2012/05/01/accepted PY - 2012/7/10/entrez PY - 2012/7/10/pubmed PY - 2013/1/24/medline SP - 578 EP - 85 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 76 IS - 3 N2 - BACKGROUND: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCP. Difficult biliary cannulation can be a procedure-related risk factor for PEP. Recent studies reported that a prophylactic pancreatic stent (PS) can reduce the frequency and severity of PEP. OBJECTIVE: To evaluate the efficacy and usefulness of a temporary 3F PS to prevent PEP in patients with difficult biliary cannulations. DESIGN: A multicenter, prospective, randomized study. SETTING: Two tertiary-care academic medical centers. PATIENTS: In total, 101 patients with a difficult biliary cannulation were randomly divided into the 3F PS placement group (PS group, n = 50) or the nonstent (NS) group (NS group, n = 51). INTERVENTIONS: Endoscopic placement of a 3F unflanged PS. MAIN OUTCOME MEASUREMENTS: The incidence and severity of PEP in the 2 groups, spontaneous dislodgment of stents, and procedure-related complications. RESULTS: The technical success rate of 3F PS placement was 96% (48/50). The lengths of the stents were 4 cm (n = 21), 6 cm (n = 15), and 8 cm (n = 12). Spontaneous stent dislodgment within 7 days occurred in 94% of patients (45/48). The mean duration until spontaneous dislodgment was 3.5 days. The incidence rate of PEP was 12% (6/50: mild, 5; moderate, 1) in the PS group and 29.4% (15/51: mild, 12; moderate, 2; severe, 1) in the NS group. Severe pancreatitis occurred in only 1 patient in the NS group. In a multivariate analysis, prophylactic placement of PS was the only prophylactic factor for PEP (odds ratio, 0.126; 95% CI, 0.025-0.632, P = .012). LIMITATIONS: No comparative results for stent size and diameter and a low-risk cohort group. CONCLUSIONS: Prophylactic temporary 3F PS placement in patients with a difficult biliary cannulation during ERCP seems to be a safe and effective method for reducing PEP and results in a high rate of spontaneous passage of stents without complications. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/22771100/Prophylactic_temporary_3F_pancreatic_duct_stent_to_prevent_post_ERCP_pancreatitis_in_patients_with_a_difficult_biliary_cannulation:_a_multicenter_prospective_randomized_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(12)02236-5 DB - PRIME DP - Unbound Medicine ER -