A survey of physician practices on prophylactic pancreatic stents

Brackbill, Stephen; Young, Scott D.; Schoenfeld, Philip; Elta, Grace H.

doi:10.1016/j.gie.2006.01.058

Cited by 67 publications

(62 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Universal agreement among participants regarding the use of prophylactic pancreatic stenting for ampullectomy was seen. This corresponds to findings by Brackbill et al [24] where 100% of respondents utilized prophylactic pancreatic stenting when performing ampullectomy. Previously, in some retrospective case series, prophylactic pancreatic stenting was performed only in the setting of delayed pancreatic duct drainage [11,15,16,19] .…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

A Survey of Ampullectomy Practices

Menees¹,

Schoenfeld²,

Elta³

2007

Gastrointestinal Endoscopy

Self Cite

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 89%

“…We therefore relied on the personal knowledge of leaders in the field to choose our sample population. This was the same method utilized by Brackbill et al [24] ; however, we expanded the field to include more community gastroenterologists. Recall bias may also be present in these data since we are relying on self-reported data.…”

Section: Discussionmentioning

confidence: 99%

A Survey of Ampullectomy Practices

Menees¹,

Schoenfeld²,

Elta³

2007

Gastrointestinal Endoscopy

Self Cite

View full text Add to dashboard Cite

“…This recommendation has rapidly disseminated among endoscopic centers. Indeed, a recent survey of physician practices with prophylactic pancreatic stents showed that 95% of the expert biliary endoscopists surveyed used the procedure in patients at high risk of PEP [7]. …”

Section: Introductionmentioning

confidence: 99%

Pancreatic Duct Stents in the Prophylaxis of Pancreatic Damage after Endoscopic Retrograde Cholangiopancreatography: A Systematic Analysis of Benefits and Associated Risks

et al. 2007

View full text Add to dashboard Cite

Methods: The efficacy of pancreatic stenting in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) was evaluated by a meta-analysis of 6 controlled studies; 12 additional uncontrolled studies were analyzed for rates of associated risk. Results: Post-ERCP pancreatitis (PEP) developed in 16.5% of controls, and in 5.1 or 9.6% of the stent group at the per-protocol (PP) or intention-to-treat (ITT) analyses. By analyzing only the 4 randomized trials, PEP developed in 24.1% of controls, and in 6.1 or 12.0% of the stented patients at the PP or ITT analyses. Risk was significantly lower in the stent group when compared with controls: OR 0.44 (95% CI 0.24–0.81). The absolute risk reduction is 12.0 (95% CI 3.0–21.0), the number needed to treat 8 (95% CI 5–34), and the publication bias 2. ORs for mild to moderate PEP were reduced in the stent group (OR = 0.537, 95% CI 0.283–1.021), as were those for severe PEP (OR = 0.123, 95% CI 0.021–0.726). Non-pancreatic complications were 4.2%, and included early stent migration (1.4%), perforations (0.4%), bleeding (1.4%), and infections (1.0%). Conclusion: Available trials show benefit for pancreatic stenting in the prophylaxis of PEP, but more randomized studies are needed before endorsing a routine use of this endoscopic procedure.

show abstract

“…For instance, a survey of 54 advanced endoscopists revealed significant disagreements in indications for prophylactic stent placement. While all of the physicians surveyed indicated they would place a stent after ampullectomy or pancreatic sphincterotomy, 30-40% of endoscopists did not feel a pancreatic stent was necessary in patients with prior PEP or suspected sphincter of Oddi dysfunction, factors which had been identified as increasing risk for PEP [56]. …”

mentioning

confidence: 98%

Post-ERCP Pancreatitis: Mechanisms, Risk Factors, and Prevention

Zouhairi¹

2013

Pancreat Disorders Ther

View full text Add to dashboard Cite

Background and EpidemiologyAcute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP) [1,2]. The incidence of acute pancreatitis after ERCP in large prospective studies published over the last two decades ranges from 1.6 to 15.1% [3][4][5][6][7][8][9][10][11][12][13]. Most cases of post-ERCP pancreatitis (PEP) tend to be mild to moderate in severity. Only 0.4% of patients undergoing ERCP develop severe acute pancreatitis, and mortality resulting from PEP is estimated to only be 0.11%. However, the risk of PEP may be as high as 30-40% in patients with certain risk factors. Furthermore, pancreatitis is the single most common reason for ERCP-related lawsuits, accounting for up to 50% of all ERCP-related litigation [14]. Definition and GradingStudies estimating the incidence of PEP are confounded by the lack of consistency in the definition of PEP utilized by investigators. In a large cohort of patients undergoing ERCP, Testoni el al demonstrated that the incidence of PEP ranged from 5.1% to 11.7% depending on the pain duration and amylase level required to diagnose PEP [15].In an attempt to standardize the definition of PEP, Cotton et al published consensus criteria in 1991 that were based on review of over 15,000 cases. These consensus criteria require four components to diagnose PEP: elevation in serum amylase concentration greater than three times upper normal level, pancreatic-type abdominal pain, duration of pain greater than 24 hours after ERCP, and pain severe enough to require hospitalization. The consensus definition also graded PEP as mild, moderate, and severe based on hospital length of stay, and procedure complications (Table 1).While the criteria proposed by Cotton et al have been widely employed in the published literature, alternative criteria have also been utilized by researchers in the field. The Atlanta criteria, one of the more commonly used alternative consensus classifications, were published in 1992 and recently revised, and defined severe acute pancreatitis based on the presence of local or systemic complications and organ failure [16] (Table 2). MechanismsAlthough the exact mechanism of PEP is not known, several hypotheses have been proposed. Leading explanations identify mechanical trauma to the papillary orifice, hydrostatic injury, and enzymatic injury from activated proteolytic enzymes introduced from the duodenum as potential precipitants for PEP.The mechanical trauma theory proposes that injury to the papillary orifice may cause sphincter of Oddi spasm or edema of the pancreatic orifice, thereby leading to obstruction of pancreatic juice outflow, and promoting pancreatic injury and inflammation. Papillary injury can occur during ERCP by prolonged or repeated attempts at cannulating the pancreatic duct , multiple contrast injections into the pancreatic duct [17], or thermal injury from electrocautery current during sphincterotomy [18].The theory of hydrostatic injury is based on the possibility that overinjection of the pancreat...

show abstract

A survey of physician practices on prophylactic pancreatic stents

Cited by 67 publications

References 13 publications

A Survey of Ampullectomy Practices

A Survey of Ampullectomy Practices

Pancreatic Duct Stents in the Prophylaxis of Pancreatic Damage after Endoscopic Retrograde Cholangiopancreatography: A Systematic Analysis of Benefits and Associated Risks

Post-ERCP Pancreatitis: Mechanisms, Risk Factors, and Prevention

Contact Info

Product

Resources

About