Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients

Amy Smithline, William Silverman, David Rogers, Rodney Nisi, Maurits Wiersema, Priya Jamidar, Robert Hawes, Glen Lehman

Research output: Contribution to journalArticle

167 Scopus citations

Abstract

Pancreatitis is a common complication of endoscopic sphincterotomy. Cautery-induced papillary edema has been implicated as a possible cause. The objective of this study was to determine whether prophylactic stenting of the main pancreatic duct after endoscopic sphincterotomy in high-risk patients would reduce the incidence of pancreatitis. High-risk patients were defined as those with sphincter of Oddi dysfunction, small common bile duct diameter (<10 mm), or those requiring pre-cut sphincterotomy. Patients were studied in a prospective fashion from October 1990 to April 1992 and were randomized to receive either a main pancreatic duct stent or no stent after biliary sphincterotomy. The stents were generally removed 10 to 14 days after placement. Fifty patients were randomized to the no-stent group and 48 patients were randomized to the stent group, but in five patients stent placement was unsuccessful. Pancreatitis occurred in 18% of patients in the no-stent group compared with 14% of patients in the stent group. Most cases of pancreatitis were mild, occurring in 10% of patients in the no-stent group and 12% of patients in the stent group. Moderate to severe pancreatitis occurred with an increased frequency in patients in the no-stent group (8%) compared with that in patients in the stent group (2%). Mean number of hospital days required to treat pancreatitis was 9.5 days in the no-stent group compared with 2.8 days in the stent group; however, none of these differences reached statistical significance. Small common bile duct diameter (<6 mm) was found to be an independent risk factor for pancreatitis after endoscopic sphincterotomy. In summary, prophylactic stenting of the main pancreatic duct did not decrease the incidence of pancreatitis in high-risk patients. Such stenting is not recommended for clinical practice.

Original languageEnglish (US)
Pages (from-to)652-657
Number of pages6
JournalGastrointestinal endoscopy
Volume39
Issue number5
DOIs
StatePublished - 1993

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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