Endoscopic Pancreatic Duct Stents Reduce the Incidence of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients

Sofuni, Atsushi; Maguchi, Hiroyuki; Mukai, Tsuyoshi; Kawakami, Hiroshi; Irisawa, Atsushi; Kubota, Kensuke; Okaniwa, Shinji; Kikuyama, Masataka; Kutsumi, Hiromu; Hanada, Keiji; Ueki, Toshiharu

doi:10.1016/j.cgh.2011.06.033

Cited by 142 publications

(108 citation statements)

References 29 publications

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“…In fact, its placement is recommended when performing ERCP in high-risk patients (15). However, much less evidence exists regarding its use in patients with a low risk of PEP and as a consequence, its extensive use is still under debate (16).…”

Section: Discussionmentioning

confidence: 99%

Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study

et al. 2016

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Background:The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement.Aim: To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. Materials and methods:This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared.Results: Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs. 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered.Conclusion: Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.

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Section: Discussionmentioning

confidence: 99%

Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study

et al. 2016

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“…Some studies have reported that short 5 F stents without proximal flaps effectively prevent PEP but the risk of PEP in controls was high (12%-15%). [102][103][104][105] In those studies, however, the subjects were mostly average-risk patients. Das et al 106 conducted a cost-effectiveness analysis comparing no PPS, PPS in only high-risk patients, and PPS in all patients.…”

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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“…Long-term PS retention is a significant risk factor with respect to chronic pancreatitis (1,(25)(26)(27)(28). Rashdan et al (25) reported that 3 -4-Fr stents are more effective than traditionally used stents for preventing PEP, and that 5 -6-Fr stents cause more significant stent-induced pancreatic duct changes than 3 -4-Fr stents.…”

Section: Type Of Stentmentioning

confidence: 99%

“…We previously (28) identified the risk factors of PEP on multivariate analysis as procedurerelated risk factors such as initial pancreatography, non-placement of a pancreatic stent (PS) after ERCP procedures, procedure time of 30 min or more, pancreatic-tissue sampling by any method, pancreatic-intraductal ultrasonography (IDUS), and difficulty of cannulation (≥ 15 min). Moreover, we evaluated the correlation between the number of risk factors and PEP.…”

Section: Risk Factors Of Post-ercp Pancreatitismentioning

confidence: 99%

“…In contrast, Smithline et al (12) reported that PS insertion did not confer a significant beneficial effect in patients with previous biliary sphincterotomy. Sofuni et al conducted 3 RCTs (15,28,43) to prospectively evaluate the usefulness of PSDS for PEP prophylaxis. In a preliminary single-center RCT (15), they evaluated PEP prophylaxis using the same unflanged 5-Fr PSDS in 80 consecutive patients, including those who underwent simple ERCP and those who received additional manipulation of the papilla through several stressful examinations including manometry, IDUS, and aspiration of pure pancreatic juice (PPJ).…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Sofuni¹,

Itoi²

2012

Pancreatitis - Treatment and Complications

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Endoscopic Pancreatic Duct Stents Reduce the Incidence of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients

Cited by 142 publications

References 29 publications

Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study

Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study

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

Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

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