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Temporary pancreatic stent to prevent post endoscopic retrograde cholangiopancreatography pancreatitis: a preliminary, single-center, randomized controlled trial

  • Takayoshi Tsuchiya
  • Takao Itoi
  • Atsushi Sofuni
  • Fumihide Itokawa
  • Toshio Kurihara
  • Kentaro Ishii
  • Syujiro Tsuji
  • Takashi Kawai
  • Fuminori Moriyasu
Original articles

Abstract

Background

Post endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis is the most common complication of ERCP, which can occasionally become serious or fatal. This preliminary study was to prospectively evaluate the efficacy of a temporary unflanged pancreatic duct stent (PS) to prevent post-ERCP pancreatitis.

Methods

A total of 64 patients were randomly divided into a control group, which did not undergo stenting, and a stent group. The stent used was a 5-Fr pigtail PS without an inner flange.

Results

Placement of an unflanged PS was successful and without complications in all 32 patients. The rates of hyperamylasemia were 50.0% and 34.4% in the control and stent groups, respectively (P > 0.05), and the mean serum amylase levels were 456.2 and 257.9 IU/l, respectively (P = 0.035). The overall rates of post-ERCP pancreatitis diagnosed according to Cotton's criteria were 12.5% and 3.1% in the control and stent groups, respectively (P > 0.05). The severity of pancreatitis was severe in one patient, moderate in one, and mild in two in the control group, whereas in the stent group, the single case of pancreatitis was mild.

Conclusions

Placement of an unflanged 5-Fr PS may be useful in preventing post-ERCP pancreatitis.

Key words

Acute pancreatitis Pancreatic stent Post-ERCP pancreatitis 

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References

  1. 1.
    Freeman, ML, Nelson, DB, Sherman, S, Haber, GB, Herman, ME, Dorsher, PJ,  et al. 1996Complications of endoscopic biliary sphincterotomyN Engl J Med33590918PubMedCrossRefGoogle Scholar
  2. 2.
    Masci, E, Toti, A, Mariani, A, Curioni, S, Lomazzi, A, Dinelli, M,  et al. 2001Complications of diagnostic and therapeutic ERCPAm J Gastroenterol9641723PubMedCrossRefGoogle Scholar
  3. 3.
    Freeman, ML, DiSario, JA, Nelson, DB, Fennety, MB, Lee, JG, Bjorkman, DJ,  et al. 2001Risk factors for post-ERCP pancreatitis: a prospective, multicenter studyGastrointest Endosc5442534PubMedCrossRefGoogle Scholar
  4. 4.
    Smithline, A, Silverman, W, Rogers, D, Nisi, R, Wiersema, M, Jamidar, P,  et al. 1993Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patientsGastrointest Endosc396527PubMedGoogle Scholar
  5. 5.
    Sherman, S, Earle, D, Bucksot, L, Esber, E, Pezzi, J, Gottlieb, K,  et al. 1995Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-induced pancreatitis? A randomized prospective study (abstract)Am J Gastroenterol901614Google Scholar
  6. 6.
    Tarnasky, PR, Palesch, YY, Cunningham, JT, Mauldin, PD, Cotton, PB, Hawes, RH 1998Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunctionGastroenterology115151824PubMedCrossRefGoogle Scholar
  7. 7.
    Patel, R, Tarnasky, P, Hennessy, WS, Hawes, R, Payne, KM, Nelles, SE,  et al. 1999Does stenting after pancreatic sphincterotomy reduce post-ERCP pancreatitis in patients with prior biliary sphincterotomy? Preliminary results of a prospective randomized trial (abstract)Gastrointest Endosc49AB80Google Scholar
  8. 8.
    Fazel, A, Quadri, A, Catalano, MF, Meyerson, SM, Geenen, JE 2003Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized studyGastrointest Endosc572914PubMedCrossRefGoogle Scholar
  9. 9.
    Freeman, ML 2004Role of pancreatic stent in prevention of post-ERCP pancreatitisJ Pancreas53227Google Scholar
  10. 10.
    Singh, P, Das, A, Isenberg, G, Wong, R, Sivak, MV, Agrawal, D,  et al. 2004Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trialsGastrointest Endosc6054450PubMedCrossRefGoogle Scholar
  11. 11.
    Rashdan, A, Fogel, EL, McHenry, L,Jr, Sherman, S, Temkit, M, Lehman, GA 2004Improved stent characteristics for prophylaxis of post-ERCP pancreatitisClin Gastroenterol Hepatol23229PubMedCrossRefGoogle Scholar
  12. 12.
    Tsujino, T, Komatsu, Y, Isayama, H, Hirano, K, Sasahira, N, Yamamoto, N,  et al. 2005Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography: a randomized, controlled trialClin Gastroenterol Hepatol337683PubMedCrossRefGoogle Scholar
  13. 13.
    Nagakawa, H, Ohara, K 2006Safeguards against acute pancreatitis associated with endoscopic papillary balloon dilatationJ Hepatobiliary Pancreat Surg13759CrossRefGoogle Scholar
  14. 14.
    Charton, JP, Deinert, K, Schumacher, B, Neuhaus, H 2004Endoscopic resection for neoplastic diseases of the papilla of VaterJ Hepatobiliary Pancreat Surg1124551PubMedCrossRefGoogle Scholar
  15. 15.
    Cotton, PB, Lehman, G, Vennes, J, Geenen, JE, Russell, RCG, Meyers, WC,  et al. 1991Endoscopic sphincterotomy complications and their management: an attempt at consensusGastrointest Endosc3738393PubMedGoogle Scholar
  16. 16.
    Kawashima, H, Hirota, Y, Itoh, A, Hara, K, Kanamori, A, Uchida, H,  et al. 2006Progress of endoscopic ultrasonography and intraductal ultrasonography in the diagnosis of malignant biliary diseaseJ Hepatobiliary Pancreat Surg136974PubMedCrossRefGoogle Scholar
  17. 17.
    Messmann, H, Vogt, W, Holstege, A, Lock, G, Heinisch, J 1997Post-ERCP pancreatitis as a model for cytokine-induced acute phase response in acute pancreatitisGut40805PubMedGoogle Scholar
  18. 18.
    Akashi, R, Tanaka, T, Kiyozumi, T, Itou, K, Sagara, K, Miyazaki, SM 2002Severe abdominal pain in the early stage of pancreatitis is helpful in the early recognition of aggravation of the pancreatitis (in Japanese with English abstract)Nippon Suizou Gakkaishi (J Jpn Pancreat Soc)2520511Google Scholar
  19. 19.
    Kozarek, RA 1990Pancreatic stent can induce ductal changes consistent with chronic pancreatitisGastrointest Endosc36935PubMedGoogle Scholar
  20. 20.
    Sherman, S, Hawes, RH, Savides, TJ, Gress, FG, Ikenberry, SO, Smith, MT,  et al. 1996Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCPGastrointest Endosc4427682PubMedCrossRefGoogle Scholar
  21. 21.
    Siegel, J, Veerappan, A 1991Endoscopic management of pancreatic disorders: potential risk of pancreatic prosthesesEndoscopy2317780PubMedCrossRefGoogle Scholar
  22. 22.
    Smith, MT, Sherman, S, Ikenberry, SO, Hawes, RH, Lehman, GA 1996Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapyGastrointest Endosc4426875PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Takayoshi Tsuchiya
    • 1
  • Takao Itoi
    • 1
  • Atsushi Sofuni
    • 1
  • Fumihide Itokawa
    • 1
  • Toshio Kurihara
    • 1
  • Kentaro Ishii
    • 1
  • Syujiro Tsuji
    • 1
  • Takashi Kawai
    • 2
  • Fuminori Moriyasu
    • 1
  1. 1.Division of Gastroenterology, Department of Internal MedicineTokyo Medical UniversityTokyoJapan
  2. 2.Endoscopic CenterTokyo Medical UniversityTokyoJapan

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