Sphincter of Oddi Dysfunction: Pancreaticobiliary Sphincterotomy with Pancreatic Stent Placement Has a Lower Rate of Pancreatitis Than Biliary Sphincterotomy Alone

Fogel, Evan L.; Eversman, D.; Jamidar, Priya A.; Sherman, Stuart; Lehman, Glen A.

doi:10.1055/s-2002-23629

Cited by 167 publications

(91 citation statements)

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“…Since these agents require continuous and prolonged IV infusion, they are not suited for same-day outpatient ERCP [34] . Several prospective randomized studies have shown that pancreatic stents have a beneficial role for prevention of pancreatitis in high-risk patients, including biliary and pancreatic sphincterotomy for SOD [40][41][42] , biliary balloon dilation for stone [43] and precut biliary sphincterotomy [21] . Although pancreatic stenting is …”

Section: Discussionmentioning

confidence: 99%

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Senol¹,

Sarıtaş²,

Demirkan³

2009

WJG

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AIM:To assess the efficacy of intramuscular diclofenac and fluid replacement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS:A prospective, placebo-controlled study was conducted in 80 patients who underwent ERCP. Patients were randomized to receive parenteral diclofenac at a loading dose of 75 mg followed by the infusion of 5-10 mL/kg per hour isotonic saline over 4 h after the procedure, or the infusion of 500 mL isotonic saline as placebo. Patients were evaluated clinically, and serum amylase levels were measured 4, 8 and 24 h after the procedure. RESULTS:The two groups were matched for age, sex, underlying disease, ERCP findings, and type of treatment. The overall incidence of pancreatitis was 7.5% in the diclofenac group and 17.5% in the placebo group (12.5% in total). There were no significant differences in the incidence of pancreatitis and other variables between the two groups. In the subgroup analysis, the frequency of pancreatitis in the patients without sphincter of Oddi dysfunction (SOD) was significantly lower in the diclofenac group than in the control group (P = 0.047).CONCLUSION: Intramuscular diclofenac and fluid replacement lowered the rate of pancreatitis in patients without SOD.

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Section: Discussionmentioning

confidence: 99%

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Senol¹,

Sarıtaş²,

Demirkan³

2009

WJG

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“…Complications of pre-cut sphincterotomy may also vary with the indication for the procedure; in a multicenter study in which a pancreatic stent was seldom placed, precut papillotomy was associated with a higher overall rate of pancreatitis (15.3%); but, when performed for SOD, the rate was 35.3% (25% severe) compared with 11.3% (2% severe) for other indications (P = 0.01) [38] . In contrast, a subsequent study showed that needle-knife papillotomy over a pancreatic stent placed during the early stages of the procedure was shown to be substantially safer than conventional pull-type sphincterotomy without a pancreatic stent in patients with SOD [18] . Overall, the data thus suggest that traditional methods of pre-cut papillotomy are potentially injurious to the pancreas, albeit effective in experienced hands and probably safer than a protracted effort at cannulation.…”

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 93%

“…Pancreatic stents generally should be left in place for a minimum of 2-3 d but should be removed endoscopically (repeat pancreatography usually not required) within 2-3 wk from a normal duct if spontaneous passage is not documented by a plain abdominal radiograph. Use of such prophylactic pancreatic stents in large referral centers have shown a significant reduction in rates of PEP including severe cases (Table 1) [15][16][17][18][19][20][21][22][23] .…”

Section: H Ow T O Ove R C O M E C a N Nu L A T I O N T R A U M A ? S mentioning

confidence: 99%

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Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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“…One of the most likely mechanisms is impaired drainage from the pancreatic duct caused by papillary edema or spasm of the sphincter of Oddi after ERCP procedures (10)(11)(12)(13)(14)19,22,25). Another is local injury of the papilla and pancreatic duct as a result of ERCP procedures, or forceful and repetitive contrast injections causing local inflammation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)26). This may lead to premature intracellular activation of proteolytic enzymes, consequently causing further damage and local inflammation as indicated by increased levels of cytokines, and possible initiation of a systemic inflammatory response with multi-organ involvement (1,10,11,13).…”

Section: Mechanisms Of Post-ercp Pancreatitismentioning

confidence: 99%

Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Sofuni¹,

Itoi²

2012

Pancreatitis - Treatment and Complications

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Sphincter of Oddi Dysfunction: Pancreaticobiliary Sphincterotomy with Pancreatic Stent Placement Has a Lower Rate of Pancreatitis Than Biliary Sphincterotomy Alone

Abstract: In SOD patients, post-ERCP pancreatitis rates remain high, but have improved with the addition of combined pancreaticobiliary sphincter therapy.

Cited by 167 publications

References 15 publications

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

Pancreatits after endoscopic retrograde cholangio-pancreatography

Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

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