Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

Sugimoto, Mitsuru; Takagi, Tadayuki; Suzuki, Rei; Konno, Naoki; Asama, Hiroyuki; Sato, Yuki; Irie, Hiroki; Watanabe, Ko; Nakamura, Jun; Kikuchi, Hitomi; Waragai, Yuichi; Takasumi, Mika; Hikichi, Takuto; Ohira, Hiromasa

doi:10.3748/wjg.v24.i22.2392

Cited by 25 publications

(16 citation statements)

References 31 publications

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“…Guidewire use and pancreatic duct stent placement were recommended in several studies [9,23,24]. However, it must be kept in mind that the number of attempts and pancreatic stents also affect the incidence rate of PEP.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-ERCP cholangitis is not mentioned as a risk factor in most studies about PEP, but Wirsung cannulation, although there are inconsistent data, was found as a risk factor for PEP. Guidewire use and pancreatic duct stent placement were recommended in several studies [ 9 , 23 , 24 ]. However, it must be kept in mind that the number of attempts and pancreatic stents also affect the incidence rate of PEP.…”

Section: Discussionmentioning

confidence: 99%

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A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

Çakır

Hut

Akturk

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a tool often used for treating and diagnosing pancreaticobiliary diseases. One of the important complications of ERCP is pancreatitis. Even though transient hyperamylasemia is a more common and benign situation, it must be distinguished from post-ERCP pancreatitis. Aim To define the risk factors associated with post-ERCP pancreatitis (PEP) and tried to identify a cutoff about laboratory findings for positive or negative prediction. Material and methods We reviewed the medical files of patients who underwent ERCP for choledocholithiasis in a retrospective cohort study. The primary outcome is the risk factors associated with PEP. Receiver operator characteristics analysis was carried out for determination of cut-offs for laboratory parameters. Results The presence of cholangitis (p = 0.018), Wirsung cannulation (p = 0.008), presence of abdominal pain at 12 th and 24 th h (p < 0.001), amylase level at 12 th h (p < 0.001), C-reactive protein (CRP) levels at 6 th and 12 th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6 th and 12 th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 10 3 had negative predictive values over 70% and 90% respectively. Conclusions Physical examination and inflammatory parameters are important in diagnosis of PEP. CRP and WBC have high negative predictivity and sensitivity. Amylase level increase was most apparent 12 h after ERCP and significantly higher (p < 0.001) for the development of PEP. The first abdominal pain evaluation is meaningful at the 12 th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

Çakır

Hut

Akturk

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…However, 3 cm and 5 cm PSs are inserted into the pancreatic head in most cases. Regarding the pancreatic region where prophylactic PSs should be inserted, Sugimoto et al [45] reported that prophylactic PSs inserted up to the pancreatic body or tail were more effective for preventing post-ERCP hyperamylasemia than PSs inserted in the pancreatic head. In this study, PEP occurrence was not observed in patients in whom a PS was inserted into the pancreatic body or tail.…”

Section: Original Papermentioning

confidence: 99%

Into which Region Should a Prophylactic Pancreatic Stent Be Inserted? A Propensity Score Matching Analysis

Sugimoto

Takagi

Suzuki

et al. 2020

JGLD

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases. However, post-ERCP pancreatitis (PEP) is sometimes a mortal adverse event. Though pancreatic stent (PS) insertion has proven to be a useful prophylaxis for PEP in several past reports, the region of the pancreas into which the PS should be inserted is unknown. Therefore, this study investigated where a prophylactic PS for PEP should be inserted. Methods: In this retrospective study, we targeted 282 patients without past history of abdominal surgery and who underwent initial ERCP and insertion of prophylactic PS to prevent PEP between January 2007 and April 2019. Patients with PS insertion to the pancreatic head (head group) were compared with patients with PS insertion into the pancreatic body or tail (body/tail group) using propensity score matching for patient characteristics, ERCP procedures, and post-ERCP adverse events. Results: After propensity score matching and removing the cases with the PS passing spontaneously for ERCP procedures, 52 head group patients and 54 body/tail group patients were selected. The PEP rate was significantly higher in the head group than in the body/tail group (9.6% vs. 0%, p=0.026). Conclusion: Pancreatic stent insertion in the pancreatic body/tail was more effective for preventing PEP than PS insertion in the pancreatic head.

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“…Accordingly, the prophylaxis of PEP is of high clinical relevance and consists of several pharmacologic and procedure‐related measurements, one being the placement of pancreatic duct stents in patients at high risk for PEP 1,4–6 . The high relevance of pancreatic stents for prophylaxis of PEP has been demonstrated by several large metanalyses (Odds ratio 0.22–0.29) 7–14 and is recommended by national and international guidelines 1,4–6 . Straight 5 Fr polyethylene stents are recommended as they are easier to place and superior in the prevention of PEP than 3 Fr stents 15–17 .…”

Section: Introductionmentioning

confidence: 99%

Transabdominal ultrasonography to reduce the burden of X‐ray imaging in prophylactic pancreatic stent localization after ERCP—A prospective trial

et al. 2021

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Background Before performing endoscopy to remove prophylactic pancreatic stents placed in patients with high risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis (PEP), X‐ray imaging is recommended to confirm the stents position in the pancreatic duct. Objectives The aim of the present study was to investigate the feasibility of prophylactic pancreatic stent detection by transabdominal ultrasonography, to reduce the burden of X‐ray imaging, which is currently the golden standard. Methods All patients who received a pancreatic stent for PEP prophylaxis were included in the present prospective trial. First, stent position was determined by transabdominal ultrasonography. Afterwards, it was verified by X‐ray imaging. Retained stents were removed by esophagogastroduodenoscopy. Dislocated stents needed no further intervention. Results Fourty‐one patients were enrolled in this study. All prophylactic pancreatic stents were straight 6 cm long 5 Fr stents with external flap. All stents were removed between day 1 and 10 (median: 3 days) in all cases. In 34 of 41 cases (83.0%), the pancreatic stent was still in place on the day of examination. Twenty‐nine of 34 (85.3%) stents were detected correctly by transabdominal ultrasonography. Overlying gas prevented visualization of the pancreas in 3/41 (7.3%) cases. Sensitivity of sonographic detection of the stent was 93.5% (29/31). Six of seven stents were determined correctly as dislocated by ultrasonography. Here, specificity was 85.7%. A positive predictive value of 96.7% (29/30) was examined. The negative predictive value was 75.0% (6/8). Conclusion Transabdominal ultrasonography detects the majority of prophylactic pancreatic stents. Thereby, it helps to identify patients with an indication for endoscopy sufficiently. X‐ray imaging could subsequently be omitted in about 70% of examinations, reducing the radiation exposure for the patient and the endoscopy staff.

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Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

Cited by 25 publications

References 31 publications

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

Into which Region Should a Prophylactic Pancreatic Stent Be Inserted? A Propensity Score Matching Analysis

Transabdominal ultrasonography to reduce the burden of X‐ray imaging in prophylactic pancreatic stent localization after ERCP—A prospective trial

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