A comparison of 4‐Fr with 5‐Fr endoscopic nasopancreatic drainage catheters: A randomized, controlled trial

Abstract

Background and Aim: Although endoscopic nasopancreatic drainage (ENPD) is useful for collecting samples for pancreatic juice cytology and for treating leakage of pancreatic juice and occlusive pancreatitis, placement of the ENPD catheter is associated with complications such as post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We investigated whether an ENPD catheter with a smaller diameter could reduce the incidence of complications. Methods: Patients requiring placement of an ENPD catheter (n = 254) were enrolled and randomly assigned to one of two catheter-size groups: the 4-Fr group or the 5-Fr group. The incidence of PEP, cholangitis, and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples were compared between groups. In addition, univariate and multivariate analyses were conducted on factors associated with PEP. Results: The incidence of PEP was significantly lower in the 4-Fr group compared with the 5-Fr group (4.1% vs 12.4%, respectively; P = 0.021). The rate of cholangitis and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples did not differ between groups. Multivariate analysis revealed that the risk of PEP was 3.7 times higher when using a 5-Fr catheter than when using a 4-Fr catheter (P = 0.019). In addition, the risk of PEP was 4.1 times higher in patients with an intraductal papillary mucinous neoplasm than in those without (P = 0.0049) and 4.6 times higher in patients aged <65 than in those aged ≥65 (P = 0.0033). Conclusions: A 4-Fr catheter is as useful as a 5-Fr catheter and is associated with a significantly lower incidence of PEP.

Clinical Analysis of Early-Stage Pancreatic Cancer and Proposal for a New Diagnostic Algorithm: A Multicenter Observational Study

“…Regarding complications, PEP occurred in 7% patients, which is similar to the incidence reported previously (3.8-15.1%) [28][29][30]. We have already reported that a 4-Fr ENPD catheter can be used to reduce the risk of PEP [31]. Collection of PJC can be performed in various ways, and we consider that it is a need for complementary use of these methods, depending on the circumstances of pancreatography and abnormal MPD findings.…”

Diagnostic Yield of Serial Pancreatic Juice Aspiration Cytologic Examination With Brush Cytology for Pancreatic Ductal Stenosis

“…In this study, 4 patients (11.8%) developed PEP, and no procedure-related deaths were observed. The incidence rate of PEP has been reported to be 4.2% to 12.4% 17,20,22 . Mouri et al 22 reported that 4F ENPD tube was associated with less PEP than 5F ENPD tubes.…”

Endoscopic approach in the diagnosis of high‐grade pancreatic intraepithelial neoplasia

“…11,13,18,20,31 A randomized controlled study comparing 4-Fr with 5-Fr ENPD catheters to reduce the incidence of PEP suggested that an ENPD catheter with a smaller diameter may reduce the incidence of PEP. 42 When EUS demonstrates a hypoechoic lesion around the MPD stenosis, usually the possibility of small invasive PDAC is considered, and the tendency is to perform EUSfine needle aspiration (FNA), initially. However, even if pathologic findings of EUS-FNA are negative, it does not rule out HG-PanIN completely.…”

“…However, SPACE may be associated with a serious complication, such as post‐ERCP pancreatitis (PEP), with an incidence rate of 0–16% 11,13,18,20,31 . A randomized controlled study comparing 4‐Fr with 5‐Fr ENPD catheters to reduce the incidence of PEP suggested that an ENPD catheter with a smaller diameter may reduce the incidence of PEP 42 …”