Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

  • Hossein Ajdarkosh Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Firoozgar Hospital, Tehran
  • Gholamreza Hemasi Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Firoozgar Hospital, Tehran
  • Farhad Zamani Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Firoozgar Hospital, Tehran
  • Masoudreza Sohrabi Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Firoozgar Hospital, Tehran
  • Mohammad Mahdi Zamani Department of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran
  • Mahmoodreza Khoonsari Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Firoozgar Hospital, Tehran
DOI: https://doi.org/10.31661/gmj.v4i2.234
Keywords: Pancreatitis, Complications, Endoscopy, Pancreatic stent

Abstract

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]

Author Biography

Mohammad Mahdi Zamani, Department of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran
Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran

References

Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2012;22(3):567-86.

Feurer ME, Adler DG. Post-ERCP pancreatitis: review of current preventive strategies. Curr Opin Gastroenterol. 2012;28(3):280-6.

Elmunzer BJ, Waljee AK. Can rectal NSAIDs replace prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis? Gastroenterology. 2014;146(1):313-5.

Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003;57(3):291-4.

Zhang ZF, Yang N, Zhao G, Zhu L, Zhu Y, Wang LX. Preventive effect of ulinastatin and gabexate mesylate on post-endoscopic retrograde cholangiopancreatography pancreatitis. Chin Med J (Engl). 2010;123(18):2600-6.

Yoo KS, Huh KR, Kim YJ, Kim KO, Park CH, Hahn T, et al. Nafamostat mesilate for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective, randomized, double-blind, controlled trial. Pancreas. 2011;40(2):181-6.

Balmadrid B, Kozarek R. Prevention and management of adverse events of endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am. 2013;23(2):385-403.

Kawaguchi Y, Ogawa M, Omata F, Ito H, Shimosegawa T, Mine T. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2012;18(14):1635-41.

Pahk A, Rigaux J, Poreddy V, Smith J, Al-Kawas F. Prophylactic pancreatic stents: does size matter? A comparison of 4-Fr and 5-Fr stents in reference to post-ERCP pancreatitis and migration rate. Dig Dis Sci. 2011;56(10):3058-64.

Ito K, Fujita N, Kanno A, Matsubayashi H, Okaniwa S, Nakahara K, et al. Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: a multicenter retrospective study. Intern Med. 2011;50(24):2927-32.

Mazaki T, Mado K, Masuda H, Shiono M. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol. 2013.

Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73(2):275-82.

Kennedy PT, Russo E, Kumar N, Powell N, Bansi D, Thillainayagam A, et al. The safety and utility of prophylactic pancreatic duct stents in the prevention of post-ERCP pancreatitis: an analysis of practice in a single UK tertiary referral center. Surg Endosc. 2010;24(8):1923-8.

Das A, Singh P, Sivak MV, Jr., Chak A. Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointest Endosc. 2007;65(7):960-8.

Lee TH, Moon JH, Choi HJ, Han SH, Cheon YK, Cho YD, et al. Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study. Gastrointest Endosc. 2012;76(3):578-85.

Enestvedt BK, Ahmad NA. Pancreatic Duct Stents for the Prevention of Post ERCP Pancreatitis: For All or Some? Gastroenterology. 2012;143(2):493-6.

Pan XP, Dang T, Meng XM, Xue KC, Chang ZH, Zhang YP. Clinical study on the prevention of post-ERCP pancreatitis by pancreatic duct stenting. Cell Biochem Biophys. 2011;61(3):473-9.

Singh P, Das A, Isenberg G, Wong RC, Sivak MV, Jr., Agrawal D, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004;60(4):544-50.

Published
2015-03-16
How to Cite
Ajdarkosh, H., Hemasi, G., Zamani, F., Sohrabi, M., Zamani, M. M., & Khoonsari, M. (2015). Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Galen Medical Journal, 4(2), 67-71. https://doi.org/10.31661/gmj.v4i2.234
Issue
Vol. 4 No. 2 (2015): June 2015
Section
Original Article

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