Comparison of the outcome of acute biliary pancreatitis (ABP) treated with ERCP and biliary sphincterotomy with or without small caliber pancreatic stents – nonrandomized, prospective, dual center trial

Introduction: Recently the feasibility and safety of small caliber pancreatic duct (PD) stenting has been described in patients with acute biliary pancreatitis (ABP) but difficult sphincterotomy. The aim of the present prospective, nonrandomized study was to assess the outcome of PD stenting added to endoscopic sphinterotomy (EST) compared to conventional EST and stone extraction in patients with ABP. Methods: During the last year 116 pts with ABP referred to emergency ERCP in our endoscopy units. Non-alcoholic pts with ABP associated with biliary abnormalities on US (gallbladder stones or dilated CBD) and concomitant early elevation (>1.5N) of obstructive LFTs were selected. In 59 ABP pts successful ERCP, EST, and stone extraction were performed (control group). In the remaining 57 pts (PD stent group) EST, stone extraction and a small calibre (5F, 4–5cm) pancreatic stent insertion were applied. The indication of PD stenting was papillary oedema, PD contrast filling or difficult biliary cannulation. Thereafter, all pts were hospitalised for medical therapy and were followed up. Results: The mean age, the symptom to ERCP time, and also the mean amylase and CRP levels at initial presentation were not significantly different in the PD stent and no stent groups: 59 vs. 63 years; 36 vs. 42h; 2225 vs. 1469U/l; and 141 vs. 104U/l, respectively. The overall complication rate, such as need for ICU admission (1.7% vs. 3.3%), pancreatic necrosis with sepsis (3.5% vs. 6.7%) and pseudocyst (>6cm) formation (5.3% vs. 15.2%) were significantly more frequent in the control group, respectively (p<0.01). The mortality rates (0% vs. 3.3%) were comparable, reasonably low and without significant differences.

Conclusions: Temporary PD stenting with small calibre stents may offer sufficient drainage to reverse the process of ABP. Small caliber PD stenting added to conventional EST may result a significantly less complications and better outcome as compared to EST alone in pts with ABP.