Transpapillary pancreatic duct stent placement can decrease the rate of post-ERCP pancreatitis in high-risk procedures

Acute pancreatitis is a significant complication of endoscopic retrograde cholangio-pancreatography (ERCP). Procedure-related factors associated with higher risk for post-ERCP pancreatitis are the opacification, inadvertent canulation of the pancreatic duct and the pre-cut sphincterotomy. It has been shown that stent placement in the pancreatic duct may decrease the risk of pancreatitis, but data are inconsistent.

Aim: of this study to test whether pancreatic stent placement reduces the frequency and severity of pancreatitis in procedures that carry extremely high risk of post-ERCP pancreatitis.

Patients And Methods: Over a 1-year period, 33 patients with high risk of post-ERCP pancreatitis were enrolled prospectively into the study. High-risk procedures were defined as pancreatic duct contrast injection, inadvertent pancreatic duct canulation and pre-cut sphincterotomy or any combination of these interventions. ERCP and sphincterotomy were performed in all patients for sphincter of Oddi dysfunction (60%) and common bile duct stone (40%). Patients were assigned into two groups where pancreatic stent was inserted (group I., n=18, mean age: 14.2, female=15). 12.3 y, female=14) or not (group II, n=25, mean age: 53.6±47.0 A 20-mm long 5-F diameter plastic stent was inserted transpapillary into the main pancreatic duct in the test group. The timing of the stent insertion during the procedure was the discretion of the endoscopist. The diagnosis of pancreatitis was based on abdominal pain requiring analgesics and elevation of serum amylase level more than two times of the normal. Severity of pancreatitis is graded mild, moderate and severe according to established criteria.

Results: The overall rate of pancreatitis was significantly lower in group II (55%) as compared to group I (88%) (p=0.031, RR: 1.548; 95% CI: 1.022–2.454). The incidence of mild pancreatitis was significantly higher in group I (50%) than in group II (9%) (p=0.018, RR: 0.181, 95% CI: 0.042–0.782). There was a trend toward the increase in frequency of moderate and severe pancreatitis in group II (68% and 22%) compared to group I (22% and 5%), but differences were not statistically significant.

Conclusions: Transpapillary pancreatic duct stent placement may be effective to decrease the incidence of post-ERCP pancreatitis in high-risk procedures.