Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients

Smithline, Amy; Silverman, William B.; Rogers, D. W. O.; Nisi, Rodney; Wiersema, Maurits J.; Jamidar, Priya A.; Hawes, Robert H.; Lehman, Glen A.

doi:10.1016/s0016-5107(93)70217-5

Cited by 171 publications

(128 citation statements)

References 11 publications

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“…Pancreatic stents generally should be left in place for a minimum of 2-3 d but should be removed endoscopically (repeat pancreatography usually not required) within 2-3 wk from a normal duct if spontaneous passage is not documented by a plain abdominal radiograph. Use of such prophylactic pancreatic stents in large referral centers have shown a significant reduction in rates of PEP including severe cases (Table 1) [15][16][17][18][19][20][21][22][23] .…”

Section: H Ow T O Ove R C O M E C a N Nu L A T I O N T R A U M A ? S mentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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Section: H Ow T O Ove R C O M E C a N Nu L A T I O N T R A U M A ? S mentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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“…Finally and most concerning, about 5%-20% of attempted PPS fails and there can be substantial risk of PEP (35%-67%) associated with failed stent placement. 101,[111][112][113][114] From a meta-analysis, the risk of PEP after failed PPS placement was 19%. 101 Attempted but failed PPS stent placement is considered to have worse consequences in highrisk patients when compared to those not treated with pancreatic stents.…”

Section: Post-ercp Prophylaxismentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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“…One of the most likely mechanisms is impaired drainage from the pancreatic duct caused by papillary edema or spasm of the sphincter of Oddi after ERCP procedures (10)(11)(12)(13)(14)19,22,25). Another is local injury of the papilla and pancreatic duct as a result of ERCP procedures, or forceful and repetitive contrast injections causing local inflammation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)26). This may lead to premature intracellular activation of proteolytic enzymes, consequently causing further damage and local inflammation as indicated by increased levels of cytokines, and possible initiation of a systemic inflammatory response with multi-organ involvement (1,10,11,13).…”

Section: Mechanisms Of Post-ercp Pancreatitismentioning

confidence: 99%

“…Moreover, the placement of a PS with internal and external flanges, or a nasopancreatic drainage tube (9,10) has been performed. To prevent PEP, some endoscopists have inserted a naso-pancreatic drainage tube into the pancreatic duct (9,10) or employed a flanged PS, apparently not considering the possible advantages of spontaneous dislodgement (10)(11)(12)(13)(14)19,20). A temporary PS has recently become commercially available and has been reported to be effective in preventing PEP (1,15,(17)(18)(19)(20)25).…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

“…Post-ERCP pancreatitis (PEP), the most common and potentially serious complication of ERCP-related procedures, occurs in 1 -9% of all procedures (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Moreover, the PEP rate increases to 10 -40% in cases with risk factors (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). In most cases, PEP is generally mild and requires only conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

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