Numerous reports show that SOD patients are at high risk for biliary sphincterotomy (BDES)- induced pancreatitis. We recently reported that needle-knife over pancreatic stent sphincterotomy (NKOPS) technique significantly lowered the pancreatitis rate in biliary precut sphincterotomy patients (GI Endosc 1994;40:124). The aim of this study was to determine whether NKOPS with pancreatic sphincterotomy (PDES:) reduces the incidence of postprocedure pancreatitis compared to standard BDES. METHODS: Since adopting this technique routinely. 93 patients wilh sphincter of Oddi manometry (SOM) documented SOD (pancreatic with or without biliary basal sphincter pressure ≥ 40 mm Hg) underwent sphincterotomy via the NKOPS+PDES method. Pancreatic stems were polyethylene 5 French, 2 cm length with half pigtail in the duodenum. Stents dislodged spontaneously (internal flange removed) or were removed in 10 days. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis (GI Endosc 1991;37:383). This group was compared to similar patients treated by biliary sphincterotomy alone without pancreatic stenting during a 2 year interval. Patients were prospectively followed for complications as part of our Quality Assurance and Continuous Quality Improvement programs. Discharged patients were called at home 24-72 hours later to assess for complications. Precut sphincterotomy patients without stents were excluded. RESULTS. PANCREATITIS SEVERITY Therapy N Pancreatitis Mild Moderate Severe Deaths BDES 104 29%*19/104 5/104 3/104 0 NKOPS+PDES 93 12%*6/93 3/93 2/93 0*Chi Square p=.02 SUMMARY: 1) NKOPS+PDES significantly decreased the frequency of post-ES pancreatitis in this high risk treatment group 2) There is a trend toward lower pancreatitis severity for the NKOPS+PDES group 3) Stents which do not spontaneously dislodge must be removed endoscopically CONCLUSIONS 1) These results need confirmation in other large centers before we recommend general use. 2) Stent modifications which encourage spontaneous passage need further evaluation.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging