Prophylactic Efficacy of 3- or 5-cm Pancreatic Stents for Preventing Post-ERCP Pancreatitis

Fujisawa, Toshio; Kagawa, Koichi; Ochiai, Kazushige; Hisatomi, Kantaro; Kubota, Kensuke; Sato, Hajime; Nakajima, Atsushi; Matsuhashi, Nobuyuki

doi:10.1097/mcg.0000000000000397

Cited by 27 publications

(22 citation statements)

References 25 publications

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“…Consequently, the stent migration rate was higher in the head group than in the body/tail group. In past reports, however, incidence of spontaneous pancreatic stent migration did not subsequently result in increased incidence of PEP[ 25 , 26 , 31 ]. Therefore, using a stent without an inner flap was not considered disadvantageous in the head group.…”

Section: Discussionmentioning

confidence: 89%

“…Meanwhile, two reports have discussed the length of the pancreatic stents. Fujisawa et al[ 26 ] compared pancreatic stent lengths (unflapped straight stent, 5 Fr at 3 cm vs 5 Fr at 5 cm) and reported that the PEP rate and the median time until stent migration were lower in the 3-cm group than in the 5-cm group. However, pancreatic sizes varied, and 3-cm or 5-cm pancreatic stents were primarily inserted at the pancreatic head.…”

Section: Introductionmentioning

confidence: 99%

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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

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2018

WJG

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AIMTo investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODSOver a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups.RESULTSPancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086) vs 78.5 (5.0-1266.5), P = 0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia (≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis.CONCLUSIONStent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2018

WJG

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“…In this report, PEP occurrence did not differ. In the report written by Fujisawa et al [44], the 5-Fr 3 cm PS was more effective for preventing PEP than the 5-Fr 5 cm PS (PEP rate: 2.0% vs 8.8% p = 0.035). As described above, Olsson et al [52] insisted that > 5-Fr, > 5 cm PS was effective in preventing PEP.…”

Section: Discussionmentioning

confidence: 92%

“…J Gastrointestin Liver Dis, September 2020 Vol. 29 No 3: 399-405 the length of the stent, Fujisawa et al [44] reported that a 5-Fr 3 cm stent was more effective for preventing PEP than a 5-Fr 5 cm stent. However, 3 cm and 5 cm PSs are inserted into the pancreatic head in most cases.…”

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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“…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, 26,27 yet the opposite conclusion was reached when comparing >3 cm 4-Fr pigtail stents to <3 cm 4-Fr straight stents. 28 Clearly, the recommended prophylactic PPS length needs to be further defined.…”

Section: T He Most Common Ae Of Ercp Remains Pepmentioning

confidence: 99%

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

Sahar

Ross

Lakhtakia

et al. 2019

Digestive Endoscopy

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Background and Aim Pancreatic plastic stents (PPS) can reduce the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4‐Fr stent designed to be deployed over a 0.035‐inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods High‐PEP‐risk patients received a 4‐Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty‐one (76%) PPS were placed using a 0.035‐inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy‐eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent‐induced ductal trauma. Post‐hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions Among high‐risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4‐Fr pancreatic duct stents compatible with a 0.035‐inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

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Prophylactic Efficacy of 3- or 5-cm Pancreatic Stents for Preventing Post-ERCP Pancreatitis

Cited by 27 publications

References 25 publications

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

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

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

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

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