A long (7 cm) prophylactic pancreatic stent decreases incidence of post-endoscopic papillectomy pancreatitis: a retrospective study

Abstract

Background and study aims Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary neoplasms and is recognized as an alternative treatment to surgical resection; however, there are few reports on a suitable pancreatic stent (PS) after EP for preventing pancreatitis. The aim of this study was to evaluate the efficacy of a long PS after EP. Patients and methods In this retrospective single-center study, 39 patients with pathologically proven ampullary neoplasms who underwent EP between March 2012 and August 2018 were enrolled. The study participants were divided into two subgroups according to the PS length: those with a PS shorter than 5 cm (short PS group, n = 17) and those with a PS of 7 cm (long PS group, n = 22). The incidence of adverse events and risk factors for pancreatitis were evaluated. Results The diameter of all PSs was 5 Fr. Post-EP pancreatitis occurred in nine patients (23.1 %), with two cases of severe pancreatitis (5.1 %). Pancreatitis occurred more frequently in the short PS group (7/17, 41.2 %) than in the long PS group (2/22, 9.1 %) ( P = 0.026). There were no significant differences between the two groups in terms of other adverse events. Univariate and multivariate analyses showed that a long PS was the only factor associated with a decreased incidence of post-EP pancreatitis ( P = 0.042; odds ratio, 0.16; 95 % confidence interval, 0.027–0.94). Conclusion A long (7 cm) PS significantly decreased incidence of pancreatitis after EP. Prospective randomized studies with a larger number of patients and wider range of PS lengths are required.

Clinical practice guidelines for endoscopic papillectomy

“…7,8,[49][50][51]56,59,60,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] In addition, the cumulative incidence rates of severe cases from the reports with severity grades were 10.2% for pancreatitis, 7.3% for bleeding, 12.5% for perforation, and 0% for cholangitis. 8,[49][50][51]56,59,60,[67][68][69][70][71][72][73][74][75][76][78][79][80][81] Moreover, four cases of death were reportedly attributed to early AEs, comprising two cases of pancreatitis and two cases of perforation. 67,75,81 The differences in the incidence rates may be attributed to differences in AE definitions and investigative methods and modalitie...…”

The feasibility of pancreatic duct stenting using a novel 4-Fr plastic stent with a 0.025-in. guidewire

“…However, early stent dislodgment may result in delayed-onset pancreatitis 14 . Delayed-onset pancreatitis because of the secondary obstruction of flow after resection or a direct burn effect in the pancreatic parenchyma is a serious complication, particularly in cases of EP 28 , 29 . Therefore, the inner flange is important for preventing early dislodgment, though the optimal stenting time is still uncertain 30 .…”

“…The study population included more patients who underwent EP than in previous studies. However, the risk of pancreatitis is high after EP 28 , 29 , 31 . The rates of PEP in our heterogeneous study population were comparable to that reported in high-risk patients with pancreatic duct stents 11 , 13 , 21 .…”

Pancreatitis poscolangiopancreatografía retrógrada endoscópica

“…De acuerdo con un estudio previo, si el extremo intraductal está a nivel de la cabeza se incrementa el riesgo de pancreatitis (OR: 3.8; IC 95%: 1.1-12.9; p = 0.03) 66 . Un escenario especial es el grupo de pacientes en quienes se realiza ampulectomía endoscópica, donde las de 7 cm parecen tener una mayor eficacia comparadas con las de 5 cm (OR: 0.16; IC 95%: 0.27-0.94; p = 0.042) 67 .…”