Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial

Ito, Kei; Fujita, Naotaka; Noda, Yutaka; Kobayashi, Go; Obana, Takashi; Horaguchi, Jun; Takasawa, Osamu; Koshita, Shinsuke; Kanno, Yoshihide; Ogawa, Takahisa

doi:10.1007/s00535-010-0268-7

Cited by 141 publications

(116 citation statements)

References 15 publications

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“…Although prophylactic pancreatic duct stenting can reduce the incidence of post-ERCP pancreatitis in patients at high risk (8)(9)(10)(11)(12)(13), it is impossible to completely prevent it. Therefore, endoscopists who perform ERCP should always be aware of the possible occurrence of this particular complication after the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Tarnasky et al (8) reported that pancreatic stent (5 or 7 Fr in diameter, 2 or 2.5 cm in length) placement reduced the incidence of post-ERCP pancreatitis from 26% to 7% in patients with pancreatic sphincter hypertension who had undergone biliary sphincterotomy. In a recent study by our group (13), pancreatic duct stent (5-Fr, 3-cm-long, single pigtail, no flanged) placement reduced the incidence of post-ERCP pancreatitis from 23% to 2.9% in patients who had undergone pancreatic duct guidewire placement for achieving selective biliary cannulation.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Post-ERCP Pancreatitis in High Risk Patients Who Have Undergone Prophylactic Pancreatic Duct Stenting: A Multicenter Retrospective Study

et al. 2011

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Background and Aim Pancreatitis remains a serious complication after endoscopic retrograde cholangiopancreatography (ERCP). The efficacy of prophylactic pancreatic duct stent placement to prevent post-ERCP pancreatitis in patients at high risk has been established in several randomized controlled trials. The aim of this study was to investigate the frequency and risk factors of post-ERCP pancreatitis in patients who had undergone prophylactic pancreatic duct stenting. Patients and Methods Between July 2002 and January 2010, ERCP-related procedures were performed in 9192 cases of pancreatobiliary diseases at seven institutions. Among them, 414 patients (246 men, 168 women; mean age, 68 yr; age range, 22-91 yr) at high risk of post-ERCP pancreatitis who had undergone prophylactic pancreatic duct stenting were included in this study. The stent used in the present study was a 5-Fr stent with a single duodenal pigtail, which is made of soft polyethylene and has no flange (Pit-stent: Cathex, Co., Ltd., Tokyo, Japan). The pancreatic duct stent was placed via the channel of the duodenoscope over a guidewire with the assistance of fluoroscopy at the end of the procedure. The frequency and risk factors of post-ERCP pancreatitis were investigated. Post-ERCP pancreatitis was defined based on the consensus criteria. Results Therapeutic ERCP was performed in 52% of the patients. Indications for prophylactic pancreatic duct stenting were as follows: difficult cannulation of the bile duct, 192; pancreatic duct cytology/biopsy, 95; precut sphincterotomy, 40; pancreatic sphincterotomy, 29; female gender, 28; papillectomy, 25; sphincter of Oddi dysfunction, 12; history of pancreatitis, 10. Hyperamylasemia at 18-24 h after ERCP was observed in 64% (267 patients) of the patients. Pancreatitis occurred in 9.9% (41 patients: mild, 37; moderate, 2; severe, 2). Univariate analysis revealed intraductal papillary mucinous neoplasm (IPMN) of the pancreas to be the only significant risk factor for pancreatitis (OR 2.9, 95% CI 1.2, 7.1). Multivariate analysis also showed IPMN to be the only risk factor for pancreatitis (OR 3.1, 95% CI 1.2, 7.8). The mean diameter of the pancreatic head duct in patients with IPMN who developed post-ERCP pancreatitis was significantly smaller than that in those who did not develop pancreatitis (3.0 ± 1 mm vs 4.7 ± 2.6 mm, p=0.0037). Conclusion Post-ERCP pancreatitis developed in 9.9% of the patients at high risk who had undergone prophylactic pancreatic duct stenting. Since the majority of cases of post-ERCP pancreatitis were mild, pancreatic duct stenting may contribute to lessening the severity of pancreatitis. The present results suggest that IPMN without a dilated pancreatic head duct is a possible risk factor for post-ERCP pancreatitis after prophylactic pancreatic duct stenting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Post-ERCP Pancreatitis in High Risk Patients Who Have Undergone Prophylactic Pancreatic Duct Stenting: A Multicenter Retrospective Study

et al. 2011

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“…Independent risks for PEP were found to be female gender (OR: 1.84, P =0.002), age≤60 years (OR: 1.59, P =0.025), cannulation time >10 min (OR: 1.76, P =0.012), ≥1 pancreatic deep wire pass (OR: 2.77, P <0.001), and needle-knife precut (OR: 4.34, P <0.001) Interestingly, contrast injections were not found to be independently signifi cant in this study once the other factors were adjusted for. Every subsequent study to evaluate pancreatic guidewire passage as a risk factor has resulted in the same fi nding (8)(9)(10).…”

Section: Editorialmentioning

confidence: 97%

“…Best results will come from a collective approach incorporating all of the "4 Ps-patient selection, procedural variables including very careful guidewire manipulation, pancreatic stents as indicated, and pharmacologic techniques. ( 10 ) randomized 70 patients who underwent pancreatic guidewire assisted biliary cannulation to pancreatic stent ( n =35) or no stent ( n =35) and found out that the rate of PEP was signifi cantly lower in the group with pancreatic stent (2.9 vs. 23%). Th is leads to the conclusion that if deep wire passage into PD is a risk factor and PD stents can reverse that risk, then PD wire passage should either be avoided or followed by a PD stent.…”

Section: Editorialmentioning

confidence: 99%

Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

Srinivasan

Freeman

2016

American Journal of Gastroenterology

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“…Secondly, if stenting is performed at the end of the procedure, the procedure, which already has a long duration, will be extended, since it is necessary to cannulate the main pancreatic duct once again. In addition, there is a small possibility of not inserting a pancreatic stent, which is per se associated with an increase in the PEP rate [28]. A study involving 146 patients in whom pancreatic stenting was attempted after PGW-assisted cannulation reported an unsuccessful rate of 14%; the rate of pancreatitis was 4.2% in the stent group versus 29% in the group in which it was not possible to insert a stent [29].…”

Section: Discussionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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Background/Aims: Recently the European Society of Gastrointestinal Endoscopy delivered guidelines on the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and on the papillary cannulation and sphincterotomy techniques at endoscopic retrograde cholangiopancreatography (ERCP). There are no data concerning current practices in Portugal. The aim of this study was to capture practice patterns of Portuguese pancreaticobiliary endoscopists with special interest in the prevention of PEP and cannulation techniques. Methods: A written survey was distributed to all pancreaticobiliary endoscopists attending the first Portuguese meeting dedicated to ERCP in November 2016. The main outcome measures were: technique used for standard biliary cannulation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) in PEP, attempting prophylactic pancreatic stenting after using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation was difficult, and use of precut as the first rescue technique when biliary cannulation was difficult. Results: Completed surveys were collected from 28 of the 32 pancreatobiliary endoscopists attending the meeting (answer rate 87.5%). Biliary cannulation was performed using a guidewire access technique by the majority (77%), usually with a sphincterotome. When cannulation was unsuccessful, precut was the first choice for 70%. NSAIDs were administered routinely for PEP by only 54%; PGW-assisted biliary cannulation was the first choice after failed standard cannulation for a minority of them, and only 27% reported to routinely attempt insertion of a pancreatic stent. High-volume endoscopists (> 150/year) tended to use NSAIDs and to insert a stent in PGW-assisted cannulation less often than low-volume-endoscopists (50 vs. 83.3%, p < 0.01, and 40 vs. 100%, p < 0.01, respectively). Precut was started without prior formal training by more than half of the endoscopists. Conclusions: There is a pronounced discrepancy between evidence-based guidelines and current clinical practice. This discrepancy is more pronounced in PEP prophylaxis, especially among high-volume endoscopists. Some advanced techniques in ERCP are initiated unsupervised, without any previous formal training. Key Message: There is a significant gap between guidelines and routine clinical practice.

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Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial

Abstract: Pancreatic duct stenting after P-GW for achieving selective biliary cannulation is recommended to reduce the incidence of post-ERCP pancreatitis.

Cited by 141 publications

References 15 publications

Risk Factors for Post-ERCP Pancreatitis in High Risk Patients Who Have Undergone Prophylactic Pancreatic Duct Stenting: A Multicenter Retrospective Study

Risk Factors for Post-ERCP Pancreatitis in High Risk Patients Who Have Undergone Prophylactic Pancreatic Duct Stenting: A Multicenter Retrospective Study

Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

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