Endoscopy 2019; 51(04): S232
DOI: 10.1055/s-0039-1681865
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

PROPHYLACTIC EFFICACY OF 7-CM PANCREATIC STENT PLACEMENT FOR POST ENDOSCOPIC AMPULLECTOMY PANCREATITIS

E Iwasaki
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
,
K Minami
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
,
S Fukuhara
2   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
,
S Kawasaki
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
,
H Ogata
2   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
,
T Kanai
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Endoscopic ampullectomy is a minimally invasive therapy for duodenal ampurally adenoma. With advances in endoscopic devices and methods, it became a safe and efficacious therapeutic procedure that can avoid the need for open surgery. However, there are few reports on suitable pancreatic stents after endoscopic ampullectomy. The placed pancreatic duct stent becomes unstable because of Oddi sphincter removal, so it may be better to use a relatively longer and double flapped pancreatic stent. We evaluated the length of pancreatic stent for prevention of post ampullectomy pancreatitis (PAP) retrospectively.

Methods:

This retrospective study was conducted from 2013 to 2018. Patients with pathologically proven ampurally adenoma who underwent endoscopic ampullectomy were enrolled. Predictive factors of PAP were evaluated by univariate analysis.

Results:

We reviewed 40 consecutive patients who underwent endoscopic ampullectomy without chronic pancreatitis or IPMN. After endoscopic ampullectomy, either straight 5 Fr, 5 cm or shorter plastic stent (n = 18) or a 5 Fr 7 cm or longer plastic stent (n = 22) was placed to pancreatic duct. PAP occurred 9 patients (17.5%) in our cohort. An incidence of PAP in the patient with short pancreatic stent (n = 8, 44.4%) was significantly higher than those with long pancreatic stent (n = 1, 4.5%). Univariate analysis for post ampullectomy pancreatitis showed that a short stent placement was significant risk factor for PAP (Odds ratio 16.8, 95% CI 1.8 – 153.3, p < 0.001). The reason for only one patient who developed PAP after inserting a long stent was considered to be due to perforation and pancreatic fistula associated with the mucosal resection.

Conclusions:

5Fr, 7 cm or longer pancreatic plastic stent should be used for prevention of pancreatitis after ampullectomy.