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Feasibility and safety of emergency ERCP and small-caliber pancreatic stenting as a bridging procedure in patients with acute biliary pancreatitis but difficult sphincterotomy

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Abstract

Background

The aims of the present study were: (1) to assess the feasibility and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct (PD) stenting with small-caliber stents as a bridging procedure in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy (EST) proved difficult, failed or was contraindicated, and (2) to compare the clinical outcome of those patients having emergency ERCP with and without pancreatic stent.

Method

Eighty-seven consecutive patients with ABP were referred for emergency ERCP. In 60 of these ABP patients, ERCP, EST, and stone extraction (if necessary) were performed without PD stenting. In the remaining 27 patients, small-caliber (3–5 F, 4 cm) pancreatic stent insertion was initially applied. All patients were hospitalized for medical therapy and were followed up.

Results

The mean ages, the initial symptom-to-ERCP times, the Glasgow severity scores, and the peak amylase and CRP levels at initial presentation were not significantly different in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group. More importantly, the complication rate was significantly lower in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group (7.4% vs. 25%); while the mortality rates (0% vs. 6.7%) were comparable, reasonably low, and demonstrated no statistically significant differences.

Conclusions

Temporary PD stenting with small-caliber stents is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP and serve as a bridging procedure in severe ABP in patients with failed, complicated, or contraindicated biliary EST.

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References

  1. Opie EL (1901) The etiology of acute hemorrhagic pancreatitis. Bull Johns Hopkins Hosp 12:182

    Google Scholar 

  2. Lium R, Portsmouth NH, Maddock S (1948) Etiology of acute pancreatitis. Surgery 24:593–604

    CAS  PubMed  Google Scholar 

  3. Bilchik AJ, Leach SD, Zucker KA, Modlin IM (1990) Experimental models of acute pancreatitis. J Surg Res 48(6):639–647

    Article  CAS  PubMed  Google Scholar 

  4. Archibald E (1919) The experimental production of pancreatitis in animals as the result of the resistance of the common duct sphincter. Surg Gynecol Obstet 28:529–545

    Google Scholar 

  5. Nardi GL, Acosta JM (1996) Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test, operative pancreatography and histologic evaluation. Ann Surg 164:611–621

    Google Scholar 

  6. Isogai M, Yamaguchi A, Harada T, Kaneoka Y, Washizu J, Aikawa K (2005) Gallstone pancreatitis: positive correlation between severe pancreatitis and passed stone. J Hepatobiliary Pancreat Surg 12(2):116–122

    Article  PubMed  Google Scholar 

  7. Safrany L, Cotton PB (1981) A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis. Surgery 89(4):424–428

    CAS  PubMed  Google Scholar 

  8. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP (1988) Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 2(8618):979–983

    Article  CAS  PubMed  Google Scholar 

  9. Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J (1993) Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 328(4):228–232

    Article  CAS  PubMed  Google Scholar 

  10. Nowak A, Nowakowska-Dulawa E, Marek TA et al (1995) Final results of the prospective, randomized controlled study on endoscopic sphincterotomy versus conventional management in acute biliary pancreatitis. Gastroenterology 108(Suppl A):380

    Google Scholar 

  11. Acosta JM, Katkhouda N, Debian KA, Groshen SG, Tsao-Wei DD, Berne TV (2006) Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg 243(1):33–40

    Article  PubMed  Google Scholar 

  12. Fölsch UR, Nitsche R, Lüdtke R, Hilgers RA, Creutzfeldt W (1997) Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis. N Engl J Med 336(4):237–242

    Article  PubMed  Google Scholar 

  13. Oría A, Cimmino D, Ocampo C, Silva W, Kohan G, Zandalazini H, Szelagowski C, Chiappetta L (2007) Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 245(1):10–17

    Article  PubMed  Google Scholar 

  14. Arendt R, Moldenhauer W, Zubaidi G, Hauzeur F, Erdmann K (1979) Deep duodenoscopy and ERCP. Z Gesamte Inn Med 34(15 suppl):205–208

    PubMed  Google Scholar 

  15. Smithline A, Silverman W, Rogers D, Nisi R, Wiersema M, Jamidar P, Hawes R, Lehman G (1993) Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients. Gastrointest Endosc 39(5):652–657

    Article  CAS  PubMed  Google Scholar 

  16. Madácsy L, Kurucsai G, Fejes R, Székely A, Székely I (2008) Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis. Dig Endosc 21(1):8–13

    Article  Google Scholar 

  17. Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE (2003) Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc 57(3):291–294

    Article  PubMed  Google Scholar 

  18. Madácsy L, Kurucsai G, Joó I, Gódi S, Fejes R, Székely A (2009) Rescue ERCP and insertion of a small-caliber pancreatic stent to prevent the evolution of severe post-ERCP pancreatitis: a case-controlled series. Surg Endosc 23(8):1887–1893

    Article  PubMed  Google Scholar 

  19. Lund H, Tønnesen H, Tønnesen MH, Olsen O (2006) Long-term recurrence and death rates after acute pancreatitis. Scand J Gastroenterol 41:234–238

    Article  PubMed  Google Scholar 

  20. Kaw M, Brodmerkel GJ Jr (2002) ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc 55(2):157–162

    Article  PubMed  Google Scholar 

  21. Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, van Erpecum KJ, Gooszen HG (2008) Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials [review]. Ann Surg 247(2):250–257

    Article  PubMed  Google Scholar 

  22. Kimura Y, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Takeda K, Isaji S, Koizumi M, Satake K, Otsuki M, Matsuno S (2006) JPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis. J Hepatobiliary Pancreat Surg 13(1):56–60

    Article  PubMed  Google Scholar 

  23. Steer ML (1998) The early intraacinar cell events which occur during acute pancreatitis. Pancreas 17:31–37

    Article  CAS  PubMed  Google Scholar 

  24. Barrett TD, Yan W, Freedman JM, Lagaud GJ, Breitenbucher JG, Shankley NP (2008) Role of CCK and potential utility of CCK1 receptor antagonism in the treatment of pancreatitis induced by biliary tract obstruction. Br J Pharmacol 153(8):1650–1658

    Article  CAS  PubMed  Google Scholar 

  25. Otsuki M (2000) Pathophysiological role of cholecystokinin in humans. J Gastroenterol Hepatol 15(suppl):D71–D83

    Article  CAS  PubMed  Google Scholar 

  26. Wang GJ, Gao CF, Wei D, Wang C, Ding SQ (2009) Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol 15(12):1427–1430

    Article  PubMed  Google Scholar 

  27. Abe N, Sugiyama M, Suzuki Y, Yamaguchi T, Mori T, Atomi Y (2008) Preoperative endoscopic pancreatic stenting: a novel prophylactic measure against pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Surg 15(4):373–376

    Article  PubMed  Google Scholar 

  28. Kruszewska D, Ljungh A, Hynes SO, Pierzynowski SG (2004) Effect of the antibacterial activity of pig pancreatic juice on human multiresistant bacteria. Pancreas 28(2):191–199

    Article  PubMed  Google Scholar 

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Disclosures

R. Fejes, G. Kurucsai, I. Székely, A. Székely, A. András, L. Madácsy have no conflicts of interest or any financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy Unit, Fejér Megyei Szent György Hospital, Seregélyesi 3, Székesfehérvár, 8000, Hungary

    Roland Fejes, Gábor Kurucsai, András Székely, Iván Székely & László Madácsy

  2. Department of Surgery, Fejér Megyei Szent György Hospital, Székesfehérvár, Hungary

    Áron Altorjay

Authors
  1. Roland Fejes
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  2. Gábor Kurucsai
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  3. András Székely
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  4. Iván Székely
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  5. Áron Altorjay
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  6. László Madácsy
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Correspondence to László Madácsy.

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Fejes, R., Kurucsai, G., Székely, A. et al. Feasibility and safety of emergency ERCP and small-caliber pancreatic stenting as a bridging procedure in patients with acute biliary pancreatitis but difficult sphincterotomy. Surg Endosc 24, 1878–1885 (2010). https://doi.org/10.1007/s00464-009-0864-x

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  • DOI: https://doi.org/10.1007/s00464-009-0864-x

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