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Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation.
World J Gastroenterol 2014; 20(26):8617-23WJ

Abstract

AIM

To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation.

METHODS

Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW.

RESULTS

No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP.

CONCLUSION

In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.

Authors+Show Affiliations

Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25024617

Citation

Nakahara, Kazunari, et al. "Need for Pancreatic Stenting After Sphincterotomy in Patients With Difficult Cannulation." World Journal of Gastroenterology, vol. 20, no. 26, 2014, pp. 8617-23.
Nakahara K, Okuse C, Suetani K, et al. Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation. World J Gastroenterol. 2014;20(26):8617-23.
Nakahara, K., Okuse, C., Suetani, K., Michikawa, Y., Kobayashi, S., Otsubo, T., & Itoh, F. (2014). Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation. World Journal of Gastroenterology, 20(26), pp. 8617-23. doi:10.3748/wjg.v20.i26.8617.
Nakahara K, et al. Need for Pancreatic Stenting After Sphincterotomy in Patients With Difficult Cannulation. World J Gastroenterol. 2014 Jul 14;20(26):8617-23. PubMed PMID: 25024617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation. AU - Nakahara,Kazunari, AU - Okuse,Chiaki, AU - Suetani,Keigo, AU - Michikawa,Yosuke, AU - Kobayashi,Shinjiro, AU - Otsubo,Takehito, AU - Itoh,Fumio, PY - 2014/01/11/received PY - 2014/03/10/revised PY - 2014/04/21/accepted PY - 2014/7/16/entrez PY - 2014/7/16/pubmed PY - 2015/4/14/medline KW - Endoscopic retrograde cholangiopancreatography KW - Endoscopic sphincterotomy KW - Pancreatic guidewire placement KW - Pancreatic stenting KW - Post-endoscopic retrograde cholangiopancreatography pancreatitis SP - 8617 EP - 23 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 26 N2 - AIM: To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation. METHODS: Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW. RESULTS: No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP. CONCLUSION: In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25024617/Need_for_pancreatic_stenting_after_sphincterotomy_in_patients_with_difficult_cannulation_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i26/8617.htm DB - PRIME DP - Unbound Medicine ER -