Clinical Study on the Prevention of Post-ERCP Pancreatitis by Pancreatic Duct Stenting

Abstract

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious complications of ERCP, which has become a major concern for digestive endoscopists. In the present study, we examine whether pancreatic duct stenting can reduce the incidence of PEP. Forty patients who underwent an ERCP in our hospital were selected according to their risk factors for PEP. They were randomly divided into two groups: (1) 20 subjects received a pancreatic duct stenting after ERCP to prevent pancreatitis (stent group, S); and (2) the other 20 subjects did not receive pancreatic duct stenting after ERCP (non-stent group, NS). Urine and serum amylase, and serum lipase were determined after the operation; symptoms of abdominal pain were monitored; cost of hospitalization was evaluated for the comparison. The results show that (1) 18 cases developed PEP, and they were significantly less in S group than in NS group (4 vs. 14 cases; P < 0.01); (2) Serum amylase was significantly lower in S group than in NS group (197.8 ± 339.7 vs. 825.4 ± 1253.4 U/l, respectively; P < 0.05); (3) The intensity of abdominal pain was 3.4 ± 0.8 in S group, compared to 4.1 ± 1.2 in NS group; (4) Duration of pharmaceutical treatment was not significantly different between the two groups (4.2 ± 1.4 vs. 6.1 ± 2.3 days, in S and NS group, respectively); and (5) The total hospitalization cost was significantly less in S group (8928 ± 2635 RMB) than in NS group (11288 ± 4325 RMB; P < 0.05). It is concluded that pancreatic duct stenting can reduce the incidence of PEP, shorten the duration of hospitalization, and therefore, lessen patients' financial burden. It is shown to be an effective way to prevent PEP.

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

“…In addition, the placement of the ENPD catheter into the caudal pancreatic duct, even with IDUS and brushing of the pancreatic duct may inhibit PEP. For the prevention of PEP, the usefulness of an endoscopic pancreatic duct stent (EPS) has been reported . These reports showed that placement of the EPS contributes to the reduction of PEP in high‐risk groups.…”

“…Because the incidence of PEP associated with ENPD catheter placement has not been reported, it was inferred. A randomized comparative study on placement of a pancreatic stent for the purpose of prevention of PEP showed that the rate of PEP after placement was 0–20% . It was assumed that the rate of PEP with a 5‐Fr ENPD catheter was 13%, and the rate of PEP with a 4‐Fr ENPD catheter was 3%.…”

“…A randomized comparative study on placement of a pancreatic stent for the purpose of prevention of PEP showed that the rate of PEP after placement was 0-20%. [8][9][10][11][12][13][14][15][16] It was assumed that the rate of PEP with a 5-Fr ENPD catheter was 13%, and the rate of PEP with a 4-Fr ENPD catheter was 3%. Using a statistical power of 80%, with the assumption of a 0.05 alpha level with a two-sided Fisher's exact test, we determined that 224 patients (112 per group) were needed.…”

Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction

“…We believe that it is important to avoid unnecessary pancreatograms when performing SEMS placements for distal MBO. Prophylactic placement of pancreatic duct stent might decrease the risk of pancreatitis after SEMS placement especially for patients with non‐pancreatic cancer because its efficacy at preventing post‐ERCP pancreatitis in high‐risk patients has been established in several randomized controlled trials …”

Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique

“…Several RCTs have demonstrated the efficacy of PS placement (Table 1). 29,30,31,32,33,34,35,36,37,38,39,40,41,42 Moreover, several meta-analyses have demonstrated its effect on PEP risk reduction compared with non-PS placement 43,44,45,46. In a recent meta-analysis that included six additional RCTs that were published since 2010, the incidence of PEP decreased from 19% in the control group to 7% 47.…”