Endoscopic Pancreatic Duct Stents Reduce the Incidence of Post¨CEndoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients

详细信息    查看全文

• 作者：Atsushi Sofuni^?/sup> ; ^{a-sofuni@amy.hi-ho.ne.jp} ; Hiroyuki Maguchi^&Dagger ; ; Tsuyoshi Mukai^§ ; ; Hiroshi Kawakami^?/sup> ; Atsushi Irisawa^¶ ; ; Kensuke Kubota^# ; Shinji Okaniwa^?? ; Masataka Kikuyama^&Dagger ; &Dagger ; ; Hiromu Kutsumi^§ ; § ; ; Keiji Hanada^¡Î¡Î ; Toshiharu Ueki^¶ ; ¶ ; ; Takao Itoi^?/sup>
• 关键词：Inflammation ; Pancreas ; Clinical Trial ; Drainage
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2011
• 出版时间：October 2011
• 年：2011
• 卷：9
• 期：10
• 页码：851-858
• 全文大小：546 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Background & Aims

Pancreatitis is the most common and potentially serious complication of post-endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is caused mostly by postprocedural papillary edema and retention of pancreatic juice. We conducted a randomized controlled trial to determine whether placement of a temporary-type, pancreatic duct stent prevents PEP and to identify risk factors for PEP.

Methods

We analyzed data from 426 consecutive patients who underwent ERCP-related procedures at 37 endoscopic units. The patients were assigned randomly to groups that received stents (S group, n = 213) or did not (nS group, n = 213). The stent used was temporary, 5F in diameter, 3 cm long, and straight with an unflanged inner end.

Results

The overall frequency of PEP was 11.3 % . The frequencies of PEP in the S and nS groups were 7.9 % and 15.2 % , respectively; the lower incidence of PEP in the S group was statistically significant based on the full analysis set (P = .021), although there was no statistically significant differences in an intention-to-treat analysis (P = .076). There were significant differences in PEP incidence between groups in multivariate analysis for the following risk factors: pancreatography first, nonplacement of a pancreatic duct stent after ERCP, procedure time of 30 minutes or more, sampling of pancreatic tissue by any method, intraductal ultrasonography, and difficulty of cannulation (?5 min). Patients with more than 3 risk factors had a significantly greater incidence of pancreatitis.

Conclusions

Placement of a pancreatic duct stent reduces the incidence of PEP. Several risk factors are associated with PEP.