Abstract
Pancreatitis is the most frequent ERCP complication and pancreatic stenting is an effective method to prevent this complication particularly, in high risk pts. Aim: 1. To compare frequency of post ERCP pancreatitis in high-risk pts after placement of either a modified 5Fr straight ST versus a 3Fr pigtail ST. 2. To compare ST efficacy and safety and determine the rate of spontaneous outward migration of these ST. Methods: 38 pts undergoing ERCP with high risk factors for developing post ERCP pancreatitis (SOD-12, ARP-13, abd pain-13 pts) were enrolled in this randomized, prospective, blinded study over a period of 1-yr with placement of 3Fr pigtail (15 pts) or 5Fr modified (no internal flap) (23 pts) straight ST. Pts had baseline amylase level drawn prior to as well as 6 & 24 hrs after procedure. Post ERCP pancreatitis was determined clinically & with enzyme levels >3ULN. Abd radiograph was obtained at 24-hrs & 7 days post ERCP to determine ST position. Pain scores from a scale of 1 to 10 were assessed pre ERCP at 6hrs, 24-hrs and 1 wk post ERCP. Phone contact was made at 24-hrs & 1 wk after the procedure to assess the clinical condition of the pt. 7 pts underwent repeat ERCP after ST placement & pancreatograms were compared. Results: Post ERCP pancreatitis rate with 3F & 5F ST were 33.3% (5/15) and 17.4% (4/23 pts) respectively (p=0.26). Mild post ERCP pancreatitis with 3F & 5F ST was 60% (3/5) & 75% (3/4) while that of moderate pancreatitis was 40% (2/5) & 25% (1/4 pts) (p=1.0) respectively. Spontaneous ST dislodgement at 24-hrs occurred in 7/13 pts with 3 Fr ST (53.8%) compared to 12/23 pts (52.2%) with 5Fr ST (p=0.92). There was no significant difference between the rate of pancreatitis and ST dislodgment at 24-hrs. No pt required repeat procedures for ST removal as all spontaneously passed within a wk. Among pts who underwent repeat ERCP none had duct changes or complications attributable to ST placement. Conclusions: Post ERCP pancreatitis rate seemed to be lower with modified straight 5Fr ST. However, there was no significance when compared with the pigtail 3Fr ST. None of these patients needed repeat endoscopy for ST removal nor were there any ST induced duct changes in those who had repeat pancreatogram.
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