Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study

Yin, Haiyan; Wu, Huiqiong; Li, Qi-Xiang; Wang, Wei; Wei-lin, OU; Xia, Harry Hua‐Xiang

doi:10.1155/2016/9687052

Cited by 17 publications

(16 citation statements)

References 44 publications

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“…These findings suggest that the flange on the PD side influences the spontaneous passage of the PS. An important technical factor, which may influence the type of temporary prophylactic PS chosen, is the technical ease of placement because prolonged and unsuccessful attempts at placement may potentially increase the risk of developing PEP 21 . In our series, the 5‐Fr PS was successfully placed for the prophylaxis of PEP in all cases.…”

Section: Discussionmentioning

confidence: 81%

Modified prophylactic 5‐fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial

Wang

Peng

et al. 2018

UEG Journal

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Background and objectives Prophylactic pancreatic duct stent placement effectively reduces post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients, but the optimal stent remains unclear. We modified a 5-Fr, 3 cm pancreatic stent by removing the flange on the pancreatic side and compared the rate of spontaneous dislodgement and complications with the ordinary stent. Methods This was a randomized controlled trial at six tertiary endoscopic centers. Patients deemed high risk for post-endoscopic retrograde cholangiopancreatography pancreatitis randomly received modified or ordinary pancreatic stent. The primary outcome was spontaneous stent dislodgement at five days and 14 days. Secondary outcomes were the success rate of stent placement and complications. Results A total of 276 patients were randomly assigned to receive modified stents (mS group) and ordinary stents (oS group). The placement of a pancreatic stent was successful in all 276 patients. There were no significant differences between groups with respect to age, sex, major diagnosis, or indications for stenting. At five days the spontaneous dislodgement rate was 47.72% for the mS group and 15.67% for the oS group ( p<0.001); at 14 days the rates were 84.21% and 42.65%, respectively ( p < 0.001). Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 6.52% of all patients. There were no significant differences regarding the incidences of post-endoscopic retrograde cholangiopancreatography pancreatitis, hemorrhage or fever. Conclusions The modified short 5-Fr stent has a higher spontaneous dislodgement rate than ordinary pancreatic stent, thus obviating the need for endoscopic removal. The modified pancreatic stent does not increase the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis or other complications. The endoscopist can consider removing the flange on the pancreatic duct side for prophylactic pancreatic duct manipulation.

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Section: Discussionmentioning

confidence: 81%

Modified prophylactic 5‐fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial

Wang

Peng

et al. 2018

UEG Journal

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“…Pre-ERCP administration of rectal indometacin reduced the overall occurrence of PEP without increasing risk of bleeding[34]. Some studies reported that the combination of a temporary prophylactic pancreatic plastic stent placement and rectal non-steroidal anti-inflammatory drugs is recommended for preventing PEP in high-risk cases[34-36]. Somatostatin can reduce the incidence of PEP but has not been routinely administrated in most of centers nor recommended by guidelines as a prophylactic measure for PEP[36,37].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that the combination of a temporary prophylactic pancreatic plastic stent placement and rectal non-steroidal anti-inflammatory drugs is recommended for preventing PEP in high-risk cases[34-36]. Somatostatin can reduce the incidence of PEP but has not been routinely administrated in most of centers nor recommended by guidelines as a prophylactic measure for PEP[36,37]. Patients at high risk of PEP should be also monitored for at least 24 h to avoid occurrence of PEP after early discharge[1,7].…”

Section: Discussionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Nakeeb

Hanafy

Salah

et al. 2016

WJGE

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AIMTo detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity.METHODSThis is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected.RESULTSThe study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP.CONCLUSIONPEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

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“…In this study, the overall frequency of PEP was 11.3%, and the frequency of PEP was significantly lower in the pancreatic stent placement group than that in the non-placement group (7.9 vs. 15.2%, p = 0.0021), although there were no significant differences in an intention-to-treat analysis (p = 0.076). On the other hand, Yin et al [23] performed a randomized study of a total of 206 patients. In this study, PEP occurred in 12.6% (26/206), and the stent placement group had a significantly lower frequency of PEP than that in the non-stent placement group (7.7 vs. 17.7%, p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Can Iodixanol Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Prospective, Randomized, Controlled Trial

Ogura

Imoto

Okuda

et al. 2019

Dig Dis

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Background: It is yet not clear whether differences in the contrast medium may affect post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Aim: The aim of this study was to evaluate the rate of PEP between high osmolality contrast medium (HOCM) and iso osmolar medium (IOCM) in a prospective, randomized, controlled trial. Methods: Patients who were scheduled to undergo a diagnostic or therapeutic procedure under ERCP guidance were included. Patients were excluded from this study if they (1) were < 20 years old; (2) had acute or active pancreatitis; (3) had previously undergone ERCP; (4) had surgical altered upper gastrointestinal tract anatomy; or (5) refused to be involved in this study. Results: Seventy-five patients were randomly assigned to the IOCM group, and 71 patients were assigned to the HOCM group. PEP occurred in 27 patients (18.5%). Although there were no significant differences, the severe grade of PEP was more frequent in the HOCM group than in the IOCM group (p = 0.08). The results of the multivariate analyses for PEP were not identified as independent risk factors. Also, independent risk factors of hyperamylasemia were performing pre-cut. In subgroup analyses, HOCM was an independent risk factor for hyperamylasemia. Conclusions: In conclusion, HOCM may play a role in the development of PEP and in PEP severity grade.

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Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study

Cited by 17 publications

References 44 publications

Modified prophylactic 5‐fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial

Modified prophylactic 5‐fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Can Iodixanol Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Prospective, Randomized, Controlled Trial

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