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

Abstract Background Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this noninferiority study was to evaluate the effectiveness of pancreatic duct (PD) stenting plus pharmacological prophylaxis vs. pharmacological prophylaxis alone in the prevention of post-ERCP pancreatitis (PEP) in high risk patients. Methods In this randomized, controlled, double-blind, noninferiority trial, patients at high risk of developing PEP were randomly allocated to pharmacological prophylaxis (rectal indomethacin, sublingual isosorbide dinitrate, and intravenous hydration with Ringer’s lactate) plus PD stenting (group A) or pharmacological prophylaxis alone (group B). The rate and severity of PEP, serum amylase levels, and length of hospital stay after ERCP were assessed. Results During 21 months, a total of 414 patients (mean age 55.5 ± 17.0 years; 60.2 % female) were enrolled (207 in each group). PEP occurred in 59 patients (14.3 %, 95 % confidence interval [CI] 11.1 % – 17.9 %: 26 patients [12.6 %, 95 %CI 8.6 % – 17.6 %] in group A and 33 [15.9 %, 95 %CI 11.4 % – 21.4 %] in group B). There was no significant difference between the two groups in PEP severity (P = 0.59), amylase levels after 2 hours (P = 0.31) or 24 hours (P = 0.08), and length of hospital stay (P = 0.07). Conclusions The study failed to demonstrate noninferiority or inferiority of pharmacological prophylaxis alone compared with PD stenting plus pharmacological prophylaxis in the prevention of PEP in high risk patients.

Download Full-text

Pancreatic duct stent preventing post endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2015.01319 ◽

2015 ◽

Vol 36 (12) ◽

pp. 1319

Author(s):

Lu WEI ◽

Ping LI ◽

Chang-qing WANG

Keyword(s):

High Risk ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

High Risk Patients ◽

Pancreatic Duct Stent ◽

Risk Patients

Download Full-text

Wait-and-see policy versus cholecystectomy after endoscopic sphincterotomy for bile-duct stones in high-risk patients with co-existing gallbladder stones: A prospective randomised trial

Arab Journal of Gastroenterology ◽

10.1016/j.ajg.2014.01.005 ◽

2014 ◽

Vol 15 (1) ◽

pp. 24-26 ◽

Cited By ~ 5

Author(s):

Showkat A. Zargar ◽

Mosin Mushtaq ◽

Mashkoor A. Beg ◽

Gul Javaid ◽

Bashir A. Khan ◽

...

Keyword(s):

High Risk ◽

Bile Duct ◽

Endoscopic Sphincterotomy ◽

Randomised Trial ◽

Bile Duct Stones ◽

High Risk Patients ◽

Gallbladder Stones ◽

Prospective Randomised Trial ◽

Risk Patients ◽

Wait And See

Download Full-text

Endoscopic Pancreatic Duct Stents Reduce the Incidence of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2011.06.033 ◽

2011 ◽

Vol 9 (10) ◽

pp. 851-858 ◽

Cited By ~ 80

Author(s):

Atsushi Sofuni ◽

Hiroyuki Maguchi ◽

Tsuyoshi Mukai ◽

Hiroshi Kawakami ◽

Atsushi Irisawa ◽

...

Keyword(s):

High Risk ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

High Risk Patients ◽

Risk Patients

Download Full-text

Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis

Endoscopy International Open ◽

10.1055/a-1460-7776 ◽

2021 ◽

Vol 09 (07) ◽

pp. E979-E985

Author(s):

Abdulfatah Issak ◽

Abbinaya Elangovan ◽

Roy D. Ferguson ◽

Nisheet Waghray ◽

Dalbir S. Sandhu

Keyword(s):

Risk Factors ◽

High Risk ◽

Pancreatic Duct ◽

The United States ◽

Ct Diagnosis ◽

Snomed Ct ◽

High Risk Patients ◽

Pancreatic Duct Stent ◽

Risk Patients ◽

Rectal Indomethacin

Abstract Background and study aims Incidence of Post-ERCP pancreatitis (PEP) ranges from 1 % to 10 % in unselected patients and as high as 25 % to 30 % in high-risk patients. Rectal indomethacin administered before or immediately after an ERCP and prophylactic pancreatic duct stent placement (PPS) are associated with a reduction in the incidence of PEP. We sought to investigate the utilization rate for prophylactic rectal indomethacin and PPS in average and high-risk patients undergoing ERCP between 2014 and 2019. Patients and methods We performed a retrospective analysis in the IBM Explorys database, a pooled, national de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States from 2014 to 2019. Average and high-risk patients undergoing ERCP were identified using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) diagnosis codes. PEP was defined by the presence of SNOMED CT diagnosis of acute pancreatitis and an inpatient admission within 5 days of an ERCP procedure. Results Out of 31,050 adults who had undergone ERCP from 2014 to 2019, only 10,500 individuals (33.8 %) had a PEP prophylaxis. Rectal indomethacin and PPS accounted for 82.4 % and 12.9 % respectively. Individuals with three risk factors had the highest PEP rates followed by individuals with two risk factors. Conclusions Only one-third of all patients undergoing ERCP received prophylaxis in the form of rectal indothemacin and/or PPS in this large population-based data. Increased implementation of prophylactic use is needed in patients undergoing ERCP as supported by current guidelines.

Download Full-text