Incidence and predictors of post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction undergoing biliary or dual sphincterotomy: results from the EPISOD prospective multicenter randomized sham-controlled study

Abstract

The performance of biliary or dual sphincterotomy does not increase the risk of PEP in patients suspected of SOD. However, the high rate of PEP in patients with suspected SOD, despite pancreatic stenting in expert centers, is confirmed in this prospective study. The combined effect of duration of ERCP and sedation type on the development of PEP should be further explored.Clinicaltrials.gov registration: NCT00688662.

Risk factors of post‐ endoscopic retrograde cholangiopancreatography pancreatitis in biliary type sphincter of Oddi dysfunction in Japanese patients

“…Pancreatic stent placement was reported to be effective in the reduction of PEP in SOD . In contrast to these reports, there are some reports that pancreatic stenting cannot reduce the incidence of PEP . The present study showed that pancreatic stent placement was a risk factor for PEP in univariate analysis.…”

“…Pancreatic stenting is considered effective for prevention of PEP in SOD patients . However, in the EPISOD trial, pancreatic stenting could not sufficiently prevent PEP in suspected SOD type 3 patients . Is pancreatic stenting effective for the prevention of PEP in Japanese patients with many of type 1 and type 2 SOD cases?…”

“…15 However, in the EPISOD trial, pancreatic stenting could not sufficiently prevent PEP in suspected SOD type 3 patients. 16 Is pancreatic stenting effective for the prevention of PEP in Japanese patients with many of type 1 and type 2 SOD cases? To answer these questions, the risk factors for PEP in suspected biliary type SOD in Japanese patients were evaluated.…”

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

“…There were no significant differences noted in migration rates between the participating centers, suggesting this was not related to differences in technique or follow‐up protocols. The overall migration rate is lower than observed at comparable times in similar studies; for example, in the EPISOD trial, the retained stent rate was 10% after a median of 24 days . Reasons for the observed migration rate remain unexplained.…”

“…It should be emphasized that assessment of PPS migration was not prescribed per protocol in the immediate post‐PPS placement days; hence, observation of PPS migration was based on a wide range of assessment time points per local practice of patient follow up. Interestingly, other studies reported superiority of shorter 3‐cm 5‐Fr pancreatic stents compared to longer 5‐cm 5‐Fr stents in preventing PEP, yet the opposite conclusion was reached when comparing >3 cm 4‐Fr pigtail stents to <3 cm 4‐Fr straight stents . Clearly, the recommended prophylactic PPS length needs to be further defined.…”