Journal Article

Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial

Kobayashi, Go, Obana, Takashi, Horaguchi, Jun, Ogawa, Takahisa, Fujita, Naotaka, Kanno, Yoshihide, Noda, Yutaka, Ito, Kei, Koshita, Shinsuke, Takasawa, Osamu

2010

Overview

Background Although pancreatic duct guidewire placement (P-GW) for achieving selective biliary cannulation is reported to be effective in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) is difficult, this technique entails a possible increased risk of post-ERCP pancreatitis. We conducted a prospective randomized controlled trial to evaluate the prophylactic effect of pancreatic duct stenting on the frequency of post-ERCP pancreatitis in patients who underwent P-GW. Methods Seventy patients who underwent P-GW for achieving selective biliary cannulation were included in this study. Patients were randomly assigned to either the stent group (n = 35) or the no-stent group (n = 35). The pancreatic duct stent used was a 5-Fr, 4-cm-long stent with a single pigtail at the duodenal end (Pit-stent™). The primary endpoint was the frequency of post-ERCP pancreatitis. Results Selective biliary cannulation was achieved in 80% of the stent group and in 94% of the no-stent group (P = 0.15). Post-ERCP pancreatitis occurred in 13% (9 patients; mild). Pancreatic duct stenting was successful in 91% of the stent group. One patient in the stent group developed migration of the stent during the procedure, followed by mild pancreatitis. The frequency of post-ERCP pancreatitis in the stent group was significantly lower than that in the no-stent group (2.9 vs. 23%, relative risk 0.13, confidence interval 0.016, 0.95). Conclusion Pancreatic duct stenting after P-GW for achieving selective biliary cannulation is recommended to reduce the incidence of post-ERCP pancreatitis.

• Publisher: Japan : Springer Japan,Springer Japan,Springer,Springer Nature B.V
• Subject: Abdominal Surgery / Adult / Aged / Aged, 80 and over / Biliary cannulation / Biliary Tract / Biliary Tract Diseases - surgery / Catheterization - methods / Cholangiopancreatography, Endoscopic Retrograde - adverse effects / Cholangiopancreatography, Endoscopic Retrograde - methods / Colorectal Surgery / Endoscopic retrograde cholangiopancreatography / Female / Gastroenterology / Hepatology / Humans / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Original Article—Liver / Pancreas / Pancreatic Diseases - surgery / Pancreatic duct stenting / Pancreatic Ducts - surgery / Pancreatitis / Pancreatitis - etiology / Pancreatitis - prevention & control / Post-ERCP pancreatitis / Prevention / Prospective Studies / Stent (Surgery) / Stents / Surgical Oncology / Treatment Outcome