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Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial.
Surg Endosc 2013; 27(2):569-74SE

Abstract

BACKGROUND

Pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography (ERCP) has been recommended in patients at risk for post-ERCP pancreatitis. However, the optimal duration of stent placement remains an open question. Our aim was to compare the efficacy of pancreatic stenting for the duration of ERCP only with spontaneous dislodgment/deferred endoscopic removal in preventing post-ERCP pancreatitis after accidental wire-guided pancreatic duct cannulation.

METHODS

All patients in whom accidental wire-guided pancreatic duct cannulation had occurred during ERCP underwent immediate 5-Fr unflanged pigtail pancreatic duct stenting before attempting any other endoscopic maneuver. At the end of the ERCP, patients were randomly assigned to immediate stent removal (group A) or to leaving the stent in place (group B). Assessment of post-ERCP pancreatitis was blind.

RESULTS

Post-ERCP pancreatitis occurred in 6/21 (29 %) patients in group A and in 0/19 patients in group B (P = 0.021); the two groups were well matched for their baseline characteristics. Post-ERCP pancreatitis was mild in two patients, moderate in two patients, and severe in two patients. Stents dislodged spontaneously in 14/19 (74 %) patients within 24-96 h; uneventful endoscopic removal was carried out after 96 h in 5 cases. Proximal stent migration did not occur in any case.

CONCLUSIONS

Pancreatic duct stent placement for the duration of ERCP only does not prevent post-ERCP pancreatitis. Pancreatic stents should be left in place until spontaneous dislodgment occurs or endoscopic removal is deemed timely. 5-Fr unflanged pigtail stents remain in place for a period sufficient to prevent post-ERCP pancreatitis and do not migrate proximally.

Authors+Show Affiliations

Gastroenterologia ed Endoscopia Digestiva, Nuovo Ospedale S. Agostino-Estense, Viale Giardini 1355, 41100 Modena, Italy. r.conigliaro@ausl.mo.itNo affiliation info availableNo 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
Randomized Controlled Trial

Language

eng

PubMed ID

22926890

Citation

Conigliaro, Rita, et al. "Pancreatic Duct Stenting for the Duration of ERCP Only Does Not Prevent Pancreatitis After Accidental Pancreatic Duct Cannulation: a Prospective Randomized Trial." Surgical Endoscopy, vol. 27, no. 2, 2013, pp. 569-74.
Conigliaro R, Manta R, Bertani H, et al. Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial. Surg Endosc. 2013;27(2):569-74.
Conigliaro, R., Manta, R., Bertani, H., Manno, M., Barbera, C., Caruso, A., ... Frazzoni, M. (2013). Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial. Surgical Endoscopy, 27(2), pp. 569-74. doi:10.1007/s00464-012-2487-x.
Conigliaro R, et al. Pancreatic Duct Stenting for the Duration of ERCP Only Does Not Prevent Pancreatitis After Accidental Pancreatic Duct Cannulation: a Prospective Randomized Trial. Surg Endosc. 2013;27(2):569-74. PubMed PMID: 22926890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial. AU - Conigliaro,Rita, AU - Manta,Raffaele, AU - Bertani,Helga, AU - Manno,Mauro, AU - Barbera,Carmelo, AU - Caruso,Angelo, AU - Olivetti,Giampiero, AU - Melotti,Gianluigi, AU - Frazzoni,Marzio, Y1 - 2012/08/28/ PY - 2012/02/27/received PY - 2012/06/27/accepted PY - 2012/8/29/entrez PY - 2012/8/29/pubmed PY - 2013/8/13/medline SP - 569 EP - 74 JF - Surgical endoscopy JO - Surg Endosc VL - 27 IS - 2 N2 - BACKGROUND: Pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography (ERCP) has been recommended in patients at risk for post-ERCP pancreatitis. However, the optimal duration of stent placement remains an open question. Our aim was to compare the efficacy of pancreatic stenting for the duration of ERCP only with spontaneous dislodgment/deferred endoscopic removal in preventing post-ERCP pancreatitis after accidental wire-guided pancreatic duct cannulation. METHODS: All patients in whom accidental wire-guided pancreatic duct cannulation had occurred during ERCP underwent immediate 5-Fr unflanged pigtail pancreatic duct stenting before attempting any other endoscopic maneuver. At the end of the ERCP, patients were randomly assigned to immediate stent removal (group A) or to leaving the stent in place (group B). Assessment of post-ERCP pancreatitis was blind. RESULTS: Post-ERCP pancreatitis occurred in 6/21 (29 %) patients in group A and in 0/19 patients in group B (P = 0.021); the two groups were well matched for their baseline characteristics. Post-ERCP pancreatitis was mild in two patients, moderate in two patients, and severe in two patients. Stents dislodged spontaneously in 14/19 (74 %) patients within 24-96 h; uneventful endoscopic removal was carried out after 96 h in 5 cases. Proximal stent migration did not occur in any case. CONCLUSIONS: Pancreatic duct stent placement for the duration of ERCP only does not prevent post-ERCP pancreatitis. Pancreatic stents should be left in place until spontaneous dislodgment occurs or endoscopic removal is deemed timely. 5-Fr unflanged pigtail stents remain in place for a period sufficient to prevent post-ERCP pancreatitis and do not migrate proximally. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/22926890/Pancreatic_duct_stenting_for_the_duration_of_ERCP_only_does_not_prevent_pancreatitis_after_accidental_pancreatic_duct_cannulation:_a_prospective_randomized_trial_ L2 - https://dx.doi.org/10.1007/s00464-012-2487-x DB - PRIME DP - Unbound Medicine ER -