Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results

Abdo M. Saad, Evan Fogel, Lee McHenry, James L. Watkins, Stuart Sherman, Laura Lazzell-Pannell, Glen Lehman

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Abstract

Background: Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective: Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population. Design: Non-randomized, retrospective study. Setting: Large, tertiary referral center. Patients: From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions: PD stent placement. Main Outcome Measurement: Pancreatitis rates. Results: A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P < .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P = .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy. Limitations: Nonrandomized, retrospective design. Conclusion: Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.

Original languageEnglish
Pages (from-to)255-261
Number of pages7
JournalGastrointestinal Endoscopy
Volume67
Issue number2
DOIs
StatePublished - Feb 2008

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Sphincter of Oddi Dysfunction
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Manometry
Pancreatitis
Stents
Incidence
Tertiary Care Centers
Population

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{654316c45c004b65861c9c24c8773879,
title = "Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results",
abstract = "Background: Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective: Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population. Design: Non-randomized, retrospective study. Setting: Large, tertiary referral center. Patients: From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions: PD stent placement. Main Outcome Measurement: Pancreatitis rates. Results: A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4{\%} in group 1 and 9.0{\%} in group 2 (P = .006, odds ratio 4.1, 95{\%} CI 1.4-12.0). Other than increased PD opacification in group 1 (P < .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5{\%} to 2.7{\%} (P = .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy. Limitations: Nonrandomized, retrospective design. Conclusion: Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.",
author = "Saad, {Abdo M.} and Evan Fogel and Lee McHenry and Watkins, {James L.} and Stuart Sherman and Laura Lazzell-Pannell and Glen Lehman",
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T1 - Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results

AU - Saad, Abdo M.

AU - Fogel, Evan

AU - McHenry, Lee

AU - Watkins, James L.

AU - Sherman, Stuart

AU - Lazzell-Pannell, Laura

AU - Lehman, Glen

PY - 2008/2

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N2 - Background: Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective: Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population. Design: Non-randomized, retrospective study. Setting: Large, tertiary referral center. Patients: From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions: PD stent placement. Main Outcome Measurement: Pancreatitis rates. Results: A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P < .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P = .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy. Limitations: Nonrandomized, retrospective design. Conclusion: Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.

AB - Background: Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective: Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population. Design: Non-randomized, retrospective study. Setting: Large, tertiary referral center. Patients: From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions: PD stent placement. Main Outcome Measurement: Pancreatitis rates. Results: A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P < .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P = .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy. Limitations: Nonrandomized, retrospective design. Conclusion: Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.

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