Mo1476 Prophylactic 3F Pancreatic Duct Stent to Prevent Post-ERCP Pancreatitis in Patients With Difficult Biliary Cannulation

Abstract

Prophylactic 3F Pancreatic Duct Stent to Prevent Post-ERCP Pancreatitis in Patients With Difficult Biliary Cannulation Seung Hyo Han, Jong Ho Moon, Hyun Jong Choi, Hee Yong Yoo, Hyung Su Ahn, Seul Ki Min, Hyun Cheol Koo, Tae Hoon Lee, Young Koog Cheon, Young Deok Cho, Sang-Heum Park Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Republic of Korea; Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Seoul, Republic of Korea Objectives: Post-ERCP panreatitis is the most common and serious complication of ERCP. Difficult biliary cannulation can be one of procedure-related risk factors of post-ERCP pancreatitis. Recent studies have reported that prophylactic pancreatic stent reduce the frequency of post-ERCP pancreatitis. The aim of this study was to evaluate the efficacy of 3 Fr pancreatic stent to prevent post-ERCP pancreatitis in patients with difficult biliary cannulation. Methods: A total of 65 patients with difficult biliary selective cannulation were randomly divided into the stent group (S group, n 30) or the non-stent group (nS group, n 35). The stents used was 3 Fr Zimmon pancreatic stents. Difficult biliary cannulation was defined as the failure to achieve biliary access with more than 5 times of cannulation attempts or over 10 minutes of cannulation time. The incidence of post-ERCP pancreatitis was compared between S group and nS group. The diagonisis and severity assessment were according to Cotton’s criteria. Results : Pancreatic duct stenting was successful in all patients of S group. Spontaneous stent dislodgment within 7 days was recognized in 96.6% (29/30). No procedurerelated complication occurred. Mean serum amylase level after ERCP were 197.13 U/L and 420.77 U/L in S and nS group, respectively (p 0.005). The incidence rate of post-ERCP pancreatitis were 10% (3/30) and 31.4% (11/35) in S and nS group, respectively (p 0.036). The severity of pancreatitis was 1 moderate and 2 mild in in S group, whereas 1 severe, 2 moderate and 8 mild in nS group. Conclusions: Prophylactic pancreatic duct stent placement in patient with difficult cannulation during ERCP seems to be a safe and effective procedure to prevent for post-ERCP pancreatitis.