Abstract
Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]
Highlights
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a common therapeutic procedure for the management of biliary tract stenosis
Many studies were carried out for preventing this problem [2, 4,5,6]. This way, different prophylactic pharmaceutical solutions were introduced [3] and different surgical procedures were applied in many endoscopic retrograde cholangiopancreatography (ERCP) units [7]
Placement of pancreatic duct (PD) stent is a somehow new effort to prevent post-ERCP pancreatitis applied in difficult situations [8]; there is no consensus on indication and necessity of prophylactic PD stent placement by all gastrointestinal societies
Summary
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a common therapeutic procedure for the management of biliary tract stenosis. It could provide profound understanding about biliary and pancreatic duct (PD) pathologies. Many studies were carried out for preventing this problem [2, 4,5,6] This way, different prophylactic pharmaceutical solutions were introduced [3] and different surgical procedures were applied in many ERCP units [7]. Placement of PD stent is a somehow new effort to prevent post-ERCP pancreatitis applied in difficult situations [8]; there is no consensus on indication and necessity of prophylactic PD stent placement by all gastrointestinal societies. We designed present study to assess the impact of PD stent insertion on the rate of post-ERCP pancreatitis
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