Endoscopy 2018; 50(04): S26
DOI: 10.1055/s-0038-1637104
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 1: cannulation and adverse effects
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC PANCREATIC STENTING IN THE TREATMENT OF ACUTE POST-ERCP PANCREATITIS

S Shapovalianz
1   N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
2   Moscow University Hospital № 31, Department of Abdominal Surgery, Surgical Gastroenterology and Endoscopy, Moscow, Russian Federation
,
A Kotieva
1   N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
2   Moscow University Hospital № 31, Department of Abdominal Surgery, Surgical Gastroenterology and Endoscopy, Moscow, Russian Federation
,
E Fedorov
1   N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
2   Moscow University Hospital № 31, Department of Abdominal Surgery, Surgical Gastroenterology and Endoscopy, Moscow, Russian Federation
,
S Budzinskiy
1   N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
2   Moscow University Hospital № 31, Department of Abdominal Surgery, Surgical Gastroenterology and Endoscopy, Moscow, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available ateRef
 

Aims:

To evaluate the results of endoscopic stenting of the main pancreatic duct (MPD) in the treatment of acute post-ERCP pancreatitis (PEP).

Methods:

From 01.01.2009 till 01.01.2016 we performed 3366 retrograde endoscopic interventions on major duodenal papilla (MDP). PEP originated in 33 (0.98%) cases (29f. and 4 m.; range: 25 – 86 years; mean age 59.7 ± 11.1). The indication for primary endoscopic interventions was jaundice in all cases, caused by stenosis of the MPD and microlithiasis (21), choledocholithiasis (7), duodenal parapapillary diverticulum (2), polyps of the MDP (2) and restenosis after previously performed EPT (1). Acute pancreatitis developed after failed ERCP in 3.0% (1/33), after balloon papillodilation with extraction of bile stones in 3.0% (1/33), and after EPT in other 93,9% (31/33) pts., including nonselective EPT in 10 cases and additional virsungotomy – in 4.

Results:

Promptly after confirmation of the diagnosis of acute PEP we tried to perform stenting of the MPD in 25 out of 33 pts. and succeeded in 22 (88.0%) of them. Complications of pancreatic stenting have not been revealed; all patients recovered. The average length of hospitalization was 10.4 ± 3.7 days. Other 11 (33.3%) pts., including 3 pts. with failed attempts of stenting, underwent medical therapy and 2 of them – surgical intervention afterwards. There were 2 (18.2%) lethal outcomes in this subgroup. The average time of hospitalization was 22.0 ± 17.1 days.

Conclusions:

Endoscopic stenting of the MPD is technically feasible in 88.0% (22/25) of patients with acute PEP whom have made such attempts. Successful stenting is effective and safe method of treatment of this dreadful complication of ERCP. At the same time, in the subgroup of pts. where pancreatic stenting was not performed or failed, mortality reached 18.2% and the average length of hospitalization was 11.6 days longer.