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Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study.
Rev Esp Enferm Dig 2016; 108(9):258-562RE

Abstract

BACKGROUND

The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement.

AIM

To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography.

MATERIALS AND METHODS

This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared.

RESULTS

Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered.

CONCLUSION

Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.

Authors+Show Affiliations

Endoscopia, Hospital Posadas.Gastroenterologia, Hospital El Cruce, Argentina.Gastroenterologia, Hospital en red El Cruce, Argentina.Endoscopia, Hospital Posadas.Gastroenterologia, Hospital El Cruce.Endoscopia, Hospital Posadas.Gastroenterologia, Hospital El Cruce.Gastroenterologia, Hospital El Cruce.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27604474

Citation

Zagalsky, David, et al. "Early Precut Is as Efficient as Pancreatic Stent in Preventing post-ERCP Pancreatitis in High-risk Subjects - a Randomized Study." Revista Espanola De Enfermedades Digestivas : Organo Oficial De La Sociedad Espanola De Patologia Digestiva, vol. 108, no. 9, 2016, pp. 258-562.
Zagalsky D, Guidi MA, Curvale C, et al. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. Rev Esp Enferm Dig. 2016;108(9):258-562.
Zagalsky, D., Guidi, M. A., Curvale, C., Lasa, J., de Maria, J., Ianniccillo, H., ... Matano, R. (2016). Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. Revista Espanola De Enfermedades Digestivas : Organo Oficial De La Sociedad Espanola De Patologia Digestiva, 108(9), pp. 258-562. doi:10.17235/reed.2016.4348/2016.
Zagalsky D, et al. Early Precut Is as Efficient as Pancreatic Stent in Preventing post-ERCP Pancreatitis in High-risk Subjects - a Randomized Study. Rev Esp Enferm Dig. 2016;108(9):258-562. PubMed PMID: 27604474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. AU - Zagalsky,David, AU - Guidi,Martin Alejandro, AU - Curvale,Cecilia, AU - Lasa,Juan, AU - de Maria,Julio, AU - Ianniccillo,Hernan, AU - Hwang,Hui Jer, AU - Matano,Raúl, PY - 2016/9/9/entrez PY - 2016/9/9/pubmed PY - 2017/11/3/medline SP - 258 EP - 562 JF - Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva JO - Rev Esp Enferm Dig VL - 108 IS - 9 N2 - BACKGROUND: The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement. AIM: To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. MATERIALS AND METHODS: This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared. RESULTS: Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered. CONCLUSION: Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement. SN - 1130-0108 UR - https://www.unboundmedicine.com/medline/citation/27604474/Early_precut_is_as_efficient_as_pancreatic_stent_in_preventing_post_ERCP_pancreatitis_in_high_risk_subjects___A_randomized_study_ L2 - https://online.reed.es/Revistas/REED_2016_108_9/Contenido/pdf/vol108num9_en_5.pdf DB - PRIME DP - Unbound Medicine ER -