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Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomized, prospective study.
Gastrointest Endosc 2013; 77(2):209-16GE

Abstract

BACKGROUND

Pancreatitis is the most common major complication of ERCP and precut endoscopic sphincterotomy (ES). Prophylactic pancreatic duct (PD) stent placement has been shown to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk settings.

OBJECTIVE

To determine whether leaving a main PD stent in place after precut ES would reduce the incidence and severity of PEP.

DESIGN

Single-center, randomized, prospective study.

SETTING

Tertiary care ERCP referral center.

PATIENTS

Consecutive patients who underwent ERCP with a clear indication for biliary access and standard biliary ES whereby free cannulation of the bile duct was not possible and precut ES was undertaken.

INTERVENTIONS

When free bile duct cannulation for ES was not possible and selective PD cannulation was achieved, a PD stent was placed. Using the PD stent as a guide, we used a needle-knife sphincterotome to perform precut ES. The patients were then randomized to either leaving the PD stent in place for 7 to 10 days (stent group) or immediate removal after the procedure (stent removed group). The remaining patients who did not undergo selective PD cannulation and stent placement were not randomized (no stent group) and had a free-hand needle-knife ES performed.

MAIN OUTCOME MEASUREMENTS

Patients were prospectively followed for the development of complications. Standardized criteria were used to diagnose and grade the severity of PEP.

RESULTS

A total of 151 patients were enrolled. The groups were similar with regard to patient demographics and patient and procedure risk factors for PEP. The overall incidence of PEP was 13.2% (20/151). It occurred in 4.3% (2/46), 21.3% (10/47), and 13.8% (8/58) of patients in the stent, stent removed, and no stent groups, respectively. The stent group had a significantly lower frequency and severity of PEP compared with the stent removed group (4.3% vs 21.3%; P = .027 for frequency and 0% vs 12.8%; P = .026 for moderate and severe pancreatitis).

LIMITATIONS

Single center. Randomization scheme not optimal.

CONCLUSIONS

These data suggest that placing and maintaining a PD stent for needle-knife precut ES reduces the frequency and severity of postprocedure pancreatitis.

Authors+Show Affiliations

Division of Gastroenterology/Hepatology, 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
Randomized Controlled Trial

Language

eng

PubMed ID

23084272

Citation

Cha, Sang-Woo, et al. "Does Leaving a Main Pancreatic Duct Stent in Place Reduce the Incidence of Precut Biliary Sphincterotomy-associated Pancreatitis? a Randomized, Prospective Study." Gastrointestinal Endoscopy, vol. 77, no. 2, 2013, pp. 209-16.
Cha SW, Leung WD, Lehman GA, et al. Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomized, prospective study. Gastrointest Endosc. 2013;77(2):209-16.
Cha, S. W., Leung, W. D., Lehman, G. A., Watkins, J. L., McHenry, L., Fogel, E. L., & Sherman, S. (2013). Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomized, prospective study. Gastrointestinal Endoscopy, 77(2), pp. 209-16. doi:10.1016/j.gie.2012.08.022.
Cha SW, et al. Does Leaving a Main Pancreatic Duct Stent in Place Reduce the Incidence of Precut Biliary Sphincterotomy-associated Pancreatitis? a Randomized, Prospective Study. Gastrointest Endosc. 2013;77(2):209-16. PubMed PMID: 23084272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomized, prospective study. AU - Cha,Sang-Woo, AU - Leung,Wesley D, AU - Lehman,Glen A, AU - Watkins,James L, AU - McHenry,Lee, AU - Fogel,Evan L, AU - Sherman,Stuart, Y1 - 2012/10/22/ PY - 2012/05/08/received PY - 2012/08/21/accepted PY - 2012/10/23/entrez PY - 2012/10/23/pubmed PY - 2013/6/29/medline SP - 209 EP - 16 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 77 IS - 2 N2 - BACKGROUND: Pancreatitis is the most common major complication of ERCP and precut endoscopic sphincterotomy (ES). Prophylactic pancreatic duct (PD) stent placement has been shown to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk settings. OBJECTIVE: To determine whether leaving a main PD stent in place after precut ES would reduce the incidence and severity of PEP. DESIGN: Single-center, randomized, prospective study. SETTING: Tertiary care ERCP referral center. PATIENTS: Consecutive patients who underwent ERCP with a clear indication for biliary access and standard biliary ES whereby free cannulation of the bile duct was not possible and precut ES was undertaken. INTERVENTIONS: When free bile duct cannulation for ES was not possible and selective PD cannulation was achieved, a PD stent was placed. Using the PD stent as a guide, we used a needle-knife sphincterotome to perform precut ES. The patients were then randomized to either leaving the PD stent in place for 7 to 10 days (stent group) or immediate removal after the procedure (stent removed group). The remaining patients who did not undergo selective PD cannulation and stent placement were not randomized (no stent group) and had a free-hand needle-knife ES performed. MAIN OUTCOME MEASUREMENTS: Patients were prospectively followed for the development of complications. Standardized criteria were used to diagnose and grade the severity of PEP. RESULTS: A total of 151 patients were enrolled. The groups were similar with regard to patient demographics and patient and procedure risk factors for PEP. The overall incidence of PEP was 13.2% (20/151). It occurred in 4.3% (2/46), 21.3% (10/47), and 13.8% (8/58) of patients in the stent, stent removed, and no stent groups, respectively. The stent group had a significantly lower frequency and severity of PEP compared with the stent removed group (4.3% vs 21.3%; P = .027 for frequency and 0% vs 12.8%; P = .026 for moderate and severe pancreatitis). LIMITATIONS: Single center. Randomization scheme not optimal. CONCLUSIONS: These data suggest that placing and maintaining a PD stent for needle-knife precut ES reduces the frequency and severity of postprocedure pancreatitis. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/23084272/Does_leaving_a_main_pancreatic_duct_stent_in_place_reduce_the_incidence_of_precut_biliary_sphincterotomy_associated_pancreatitis_A_randomized_prospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(12)02643-0 DB - PRIME DP - Unbound Medicine ER -