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Comparative study of strategies for preventing post-ERCP pancreatitis after early precut sphincterotomy for biliary access.
J Dig Dis 2016; 17(10):692-696JD

Abstract

OBJECTIVE

Needle knife precut sphincterotomy (PS) during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with a high risk of post-ERCP pancreatitis (PEP). This study aimed to examine the effect of no prophylaxis, somatostatin, rectal diclofenac and pancreatic duct (PD) stenting in reducing rates of PEP in patients who underwent early PS.

METHODS

This was a retrospective comparative study and the study period was from January 2006 to December 2015. A standardized approach to early PS was used: (i) inadvertent guidewire cannulation of the PD > thrice; (ii) impacted bile duct stone; (iii) inability to achieve deep cannulation within 10 min. PEP prophylactic measures included: (i) none when there was minimal papilla trauma; (ii) somatostatin infusion; (iii) rectal diclofenac; (iv) PD stent. The difference in rates of PEP between the different strategies was analysed.

RESULTS

During the study period, PS was performed in 191 ERCP patients (mean age 66 years; 56.5% males). The ERCP success rate after PS was 93.2% (178/191). Overall the PEP rate was 3.1% (6/191) and the severity in all cases was mild. PEP occurred in 6.1% of patients with PD cannulation but not in those without (P = 0.016). PEP rates were 1.8%, 7.3%, 1.8% and 0% in control, somatostatin, diclofenac and PD stenting groups, respectively (P = 0.209).

CONCLUSIONS

There was no significant difference in PEP rates after early PS whether or not prophylactic measures were adopted if there was minimal papilla trauma. A trend towards lower PEP rates was observed in patients who had either rectal diclofenac or PD stenting, compared to somatostatin.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27556283

Citation

Ang, Tiing Leong, et al. "Comparative Study of Strategies for Preventing post-ERCP Pancreatitis After Early Precut Sphincterotomy for Biliary Access." Journal of Digestive Diseases, vol. 17, no. 10, 2016, pp. 692-696.
Ang TL, Kwek AB, Song M, et al. Comparative study of strategies for preventing post-ERCP pancreatitis after early precut sphincterotomy for biliary access. J Dig Dis. 2016;17(10):692-696.
Ang, T. L., Kwek, A. B., Song, M., Li, J. W., & Thurairajah, P. H. (2016). Comparative study of strategies for preventing post-ERCP pancreatitis after early precut sphincterotomy for biliary access. Journal of Digestive Diseases, 17(10), pp. 692-696. doi:10.1111/1751-2980.12401.
Ang TL, et al. Comparative Study of Strategies for Preventing post-ERCP Pancreatitis After Early Precut Sphincterotomy for Biliary Access. J Dig Dis. 2016;17(10):692-696. PubMed PMID: 27556283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative study of strategies for preventing post-ERCP pancreatitis after early precut sphincterotomy for biliary access. AU - Ang,Tiing Leong, AU - Kwek,Andrew Boon Eu, AU - Song,Mingjun, AU - Li,James Weiquan, AU - Thurairajah,Prem Harichander, PY - 2016/07/06/received PY - 2016/08/14/revised PY - 2016/08/21/accepted PY - 2016/8/25/pubmed PY - 2017/5/4/medline PY - 2016/8/25/entrez KW - endoscopic retrograde cholangiopancreatography KW - endoscopic sphincterotomy KW - pancreatitis KW - prophylaxis SP - 692 EP - 696 JF - Journal of digestive diseases JO - J Dig Dis VL - 17 IS - 10 N2 - OBJECTIVE: Needle knife precut sphincterotomy (PS) during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with a high risk of post-ERCP pancreatitis (PEP). This study aimed to examine the effect of no prophylaxis, somatostatin, rectal diclofenac and pancreatic duct (PD) stenting in reducing rates of PEP in patients who underwent early PS. METHODS: This was a retrospective comparative study and the study period was from January 2006 to December 2015. A standardized approach to early PS was used: (i) inadvertent guidewire cannulation of the PD > thrice; (ii) impacted bile duct stone; (iii) inability to achieve deep cannulation within 10 min. PEP prophylactic measures included: (i) none when there was minimal papilla trauma; (ii) somatostatin infusion; (iii) rectal diclofenac; (iv) PD stent. The difference in rates of PEP between the different strategies was analysed. RESULTS: During the study period, PS was performed in 191 ERCP patients (mean age 66 years; 56.5% males). The ERCP success rate after PS was 93.2% (178/191). Overall the PEP rate was 3.1% (6/191) and the severity in all cases was mild. PEP occurred in 6.1% of patients with PD cannulation but not in those without (P = 0.016). PEP rates were 1.8%, 7.3%, 1.8% and 0% in control, somatostatin, diclofenac and PD stenting groups, respectively (P = 0.209). CONCLUSIONS: There was no significant difference in PEP rates after early PS whether or not prophylactic measures were adopted if there was minimal papilla trauma. A trend towards lower PEP rates was observed in patients who had either rectal diclofenac or PD stenting, compared to somatostatin. SN - 1751-2980 UR - https://www.unboundmedicine.com/medline/citation/27556283/Comparative_study_of_strategies_for_preventing_post_ERCP_pancreatitis_after_early_precut_sphincterotomy_for_biliary_access_ L2 - https://doi.org/10.1111/1751-2980.12401 DB - PRIME DP - Unbound Medicine ER -