1. Hepatogastroenterology. 2012 Aug 22;59(120). doi: 10.5754/hge12363. [Epub ahead of print]

The Safety and Utility of Pancreatic Duct Stents in the Emergency ERCP of Acute Biliary Pancreatitis but Difficult Sphincterotomy.

Guoqian D, Mingfang Q, Wang C, Fusheng Z, Hongzhi Z.

Abstract

Background/Aims: The aims of this study were to assess the feasibility and safety of emergency ERCP and pancreatic duct (PD) stenting in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy proved difficult, and to compare the clinical outcome of those patients having emergency ERCP without pancreatic stent. Methodology: One hundred and ninety-one consecutive patients with ABP were included in this study. Patients were randomly assigned to either the stent group (n=78) or the no-stent group (n=113). In the stent group, 3-5Fr, 5-7cm-long pancreatic stent insertion was initially applied and removed endoscopically 1-2 weeks post-ERCP. All patients were hospitalized for medical therapy and were followed-up. Results: Mean age, initial symptom-to-ERCP times, Glasgow severity scores and peak amylase and CRP levels at initial presentation were not significantly different in the stent group vs. the no-stent group, and the selective biliary cannulation was achieved in 80% of the stent group and in 94% of the no-stent group (p=0.15). More importantly, the complication rate was significantly lower in the stent group (7.7% vs. 31.9%). There was no difference in mortality between the two groups statistically (1.3% vs. 3.5%). Conclusions: Pancreatic duct stenting is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP, show better outcomes as compared to no-stent group. It is recommended to reduce the incidence of the complication in the emergency ERCP of ABP but difficult sphincterotomy. However, further prospective trials are needed.

PMID: 22944289 [PubMed - as supplied by publisher] Related citations

2. Scand J Gastroenterol. 2012 Jun;47(6):729-36. doi: 10.3109/00365521.2012.660702. Epub 2012 Mar 14.

Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: better overall outcome with adequate pancreatic drainage.

Dubravcsik Z, Hritz I, Fejes R, Balogh G, Virányi Z, Hausinger P, Székely A, Szepes A, Madácsy L.

Bács-Kiskun County Hospital, Kecskemét, Teaching Hospital of the University of Szeged, Kecskemet, Hungary.

Abstract

OBJECTIVE:

To analyze the efficacy of pancreatic duct (PD) stenting following endoscopic sphincterotomy (EST) compared with EST alone in reducing complication rate and improving overall outcome in acute biliary pancreatitis (ABP).

METHODS:

Between 1 January 2009 and 1 July 2010, 141 nonalcoholic patients with clinical, laboratory and imaging evidence of ABP were enrolled. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 h from the onset of pain. Seventy patients underwent successful ERCP, EST, and stone extraction (control group); 71 patients (PD stent group) had EST, stone extraction and small-caliber (5 Fr, 3-5 cm) pancreatic stent insertion. All patients were hospitalized for medical therapy and jejunal feeding and were followed up.

RESULTS:

The mean age, Glasgow score, symptom to ERCP time, mean amylase and CRP levels at initial presentation were not significantly different in the PD stent group compared to the control group: 60.6 vs. 64.3, 3.21 vs. 3.27, 34.4 vs. 40.2, 2446.9 vs. 2114.3, 121.1 vs. 152.4, respectively. Complications (admission to intensive care unit, pancreatic necrosis with septicemia, large (>6 cm) pseudocyst formation, need for surgical necrosectomy) were less frequent in the PD stent group resulting in a significantly lower overall complication rate (9.86% vs. 31.43%, p < 0.002). Mortality rates (0% vs. 4.28%) were comparable, reasonably low and without any significant differences.

CONCLUSIONS:

Temporary small-caliber PD stent placement may offer sufficient drainage to reverse the process of ABP. Combined with EST the process results in a significantly less complication rate and better clinical outcome compared with EST alone during the early course of ABP.

PMID: 22414053 [PubMed - indexed for MEDLINE] Related citations

3. Surg Endosc. 2010 Aug;24(8):1878-85. doi: 10.1007/s00464-009-0864-x. Epub 2010 Jan 28.

Feasibility and safety of emergency ERCP and small-caliber pancreatic stenting as a bridging procedure in patients with acute biliary pancreatitis but difficult sphincterotomy.

Fejes R, Kurucsai G, Székely A, Székely I, Altorjay A, Madácsy L.

Department of Gastroenterology and Endoscopy Unit, Fejér Megyei Szent György Hospital, Seregélyesi 3, Székesfehérvár, 8000, Hungary.

Abstract

BACKGROUND:

The aims of the present study were: (1) to assess the feasibility and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct (PD) stenting with small-caliber stents as a bridging procedure in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy (EST) proved difficult, failed or was contraindicated, and (2) to compare the clinical outcome of those patients having emergency ERCP with and without pancreatic stent.

METHOD:

Eighty-seven consecutive patients with ABP were referred for emergency ERCP. In 60 of these ABP patients, ERCP, EST, and stone extraction (if necessary) were performed without PD stenting. In the remaining 27 patients, small-caliber (3-5 F, 4 cm) pancreatic stent insertion was initially applied. All patients were hospitalized for medical therapy and were followed up.

RESULTS:

The mean ages, the initial symptom-to-ERCP times, the Glasgow severity scores, and the peak amylase and CRP levels at initial presentation were not significantly different in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group. More importantly, the complication rate was significantly lower in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group (7.4% vs. 25%); while the mortality rates (0% vs. 6.7%) were comparable, reasonably low, and demonstrated no statistically significant differences.

CONCLUSIONS:

Temporary PD stenting with small-caliber stents is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP and serve as a bridging procedure in severe ABP in patients with failed, complicated, or contraindicated biliary EST.

PMID: 20108145 [PubMed - indexed for MEDLINE]