Pancreatitis is the most common complication of precut ES. The objective of this study was to determine whether leaving a pancreatic duct stent in place following precut ES would reduce the incidence and severity of post-procedure pancreatitis. METHODS: During the past 32 months, free cannulation of the bile duct for standard ES was not possible in 151 of 1,122 patients (13.5%). In 93, selective pancreatic duct cannulation was achieved and a 5-7 French, 2-25 cm main pancreatic duct stent was placed. Using the pancreatic stent as a guide, a needle-knife (NK) sphincterotome was used to cut 5-10 mm in the 11-12 o'clock direction. Once access to the bile duct was obtained, the ES was usually completed using a standard sphincterotome. Following completion of the ES, these 93 patients were randomized to leaving the pancreatic stent in place (stent) for 7-10 days or immediate removal (stent removed). The remaining 58 who did not undergo pancreatic duct stent placement (no stent), had a NK ES performed in a similar fashion. Patients were prospectively followed up for complications. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis (GI Endosc 1991;37:383). RESULTS: # PANCREATITIS/TOTAL # PATIENTS ES INDICATION STENT STENT REMOVED NO STENT TOTAL Stones 0/6 1/9 1/9 2/24 (8%) Sphincter of Oddi Dysfunction 1/24 4/19 6/19 11/62 (18%) Tumor 0/7 2/10 0/20 2/37 (5%) Miscellaneous 0/9 3/9 1/10 4/28 (14%) TOTAL 1/46 (2,2%)*10/47 (21.3%.) 8/58(13.8%) 19/151(12.6%)*P = .004, stent vs. stent removed; P = .036 stent vs. no stent Pancreatitis was graded mild in 1 in the stent group, mild in 5 and moderate in 5 in the stent removed group, and mild in 5, moderate in 1, and severe in 2 in the no stent group. The number of pancreatic duct injections, frequency of pancreatic acinarization, and the use of sphincter of Oddi manometry were similar for all three groups. SUMMARY: 1) Leaving a pancreatic duct stent in place following NK ES reduced the pancreatitis rate from 21.3% to 2.2%. 2) The pancreatitis rates were similar for the no stent and stent removed groups. CONCLUSION: These data suggest that placing and maintaining a pancreatic duct stent for NK ES reduces the frequency of postprocedure pancreatitis. Until greater safety data are available from other centers, these techniques should be reserved for experienced endoscopists.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging