Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled trial

Zolotarevsky, Eugene; Fehmi, Syed M. Abbas; Anderson, Michelle A.; Schoenfeld, Philip; Elmunzer, B. Joseph; Kwon, Richard S.; Piraka, Cyrus; Wamsteker, Erik; Scheiman, James M.; Korsnes, Sheryl J.; Normolle, Daniel P.; Kim, H. Myra; Elta, Grace H.

doi:10.1055/s-0030-1256305

Cited by 68 publications

(55 citation statements)

References 18 publications

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“…A higher rate of PS placement failure and PEP, but without statistical difference (14% in 3F group and 9% in 5F group), was observed in patients with 3F stents. Recently, Zolotarevsky et al 18 reported that placement of a 5F compared with a 3F PS for PEP prophylaxis is easier and faster and requires fewer wires. However, there was no statistically significant difference in spontaneous passage rates (5F group, 68.4%; 3F group, 75.0 %; P ϭ .617) and PEP rates (P ϭ .519).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Recent studies reported that prophylactic placement of a pancreatic stent (PS) reduces the frequency and severity of PEP in various risk groups, including those with known or suspected sphincter of Oddi dysfunction (SOD), papillectomy, precut sphincterotomy, pancreatic sphincterotomy, history of PEP, or a difficult cannulation. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The overall success rate for selective cannulation during ERCP ranges from 90% to 95%, even when performed by experts. 7 During biliary cannulation, the rate of PEP increases when cannulation is difficult and prolonged.…”

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confidence: 99%

“…In addition, the sizes and lengths of stents are variable, and no guideline or consensus yet exists regarding which type or length of PS is optimal. [16][17][18] This prospective, randomized, controlled study was designed to evaluate the efficacy and usefulness of a 3F PS to prevent PEP in patients with difficult selective biliary cannulations.…”

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Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study

Lee¹,

Lee

Han

et al. 2012

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study

Lee¹,

Lee

Han

et al. 2012

Gastrointestinal Endoscopy

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“…Recently, two meta-analyses about prophylactic pancreatic stenting for the prevention of post-ERCP pancreatitis showed a significant decrease of either the odds ratio to 0.22 or the relative risk to 0.32 [19,20]. Another randomized study showed the superiority of a 5-Fr stent over a 3-Fr stent in this indication [21]. Thus, a pancreatic prosthesis appears to be recommended.…”

Section: Discussionmentioning

confidence: 99%

Can papillary carcinomas be treated by endoscopic ampullectomy?

et al. 2011

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“…In a retrospective analysis, PEP rates were similar in patients who received 4 French or 5 French stents but spontaneous migration rate was significantly higher in the 4 French group [57]. More recently however, a randomized trial comparing 5 French to 3 French stents was terminated early for futility, since no difference was noted in the primary outcome of stent migration [58]. Three French stents do not appear to impart a large advantage in migration rate, and are significantly more difficult to place, limiting their suitability in the setting of prophylactic pancreatic stenting.…”

Section: Mildmentioning

confidence: 99%

Post-ERCP Pancreatitis: Mechanisms, Risk Factors, and Prevention

Zouhairi¹

2013

Pancreat Disorders Ther

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Background and EpidemiologyAcute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP) [1,2]. The incidence of acute pancreatitis after ERCP in large prospective studies published over the last two decades ranges from 1.6 to 15.1% [3][4][5][6][7][8][9][10][11][12][13]. Most cases of post-ERCP pancreatitis (PEP) tend to be mild to moderate in severity. Only 0.4% of patients undergoing ERCP develop severe acute pancreatitis, and mortality resulting from PEP is estimated to only be 0.11%. However, the risk of PEP may be as high as 30-40% in patients with certain risk factors. Furthermore, pancreatitis is the single most common reason for ERCP-related lawsuits, accounting for up to 50% of all ERCP-related litigation [14]. Definition and GradingStudies estimating the incidence of PEP are confounded by the lack of consistency in the definition of PEP utilized by investigators. In a large cohort of patients undergoing ERCP, Testoni el al demonstrated that the incidence of PEP ranged from 5.1% to 11.7% depending on the pain duration and amylase level required to diagnose PEP [15].In an attempt to standardize the definition of PEP, Cotton et al published consensus criteria in 1991 that were based on review of over 15,000 cases. These consensus criteria require four components to diagnose PEP: elevation in serum amylase concentration greater than three times upper normal level, pancreatic-type abdominal pain, duration of pain greater than 24 hours after ERCP, and pain severe enough to require hospitalization. The consensus definition also graded PEP as mild, moderate, and severe based on hospital length of stay, and procedure complications (Table 1).While the criteria proposed by Cotton et al have been widely employed in the published literature, alternative criteria have also been utilized by researchers in the field. The Atlanta criteria, one of the more commonly used alternative consensus classifications, were published in 1992 and recently revised, and defined severe acute pancreatitis based on the presence of local or systemic complications and organ failure [16] (Table 2). MechanismsAlthough the exact mechanism of PEP is not known, several hypotheses have been proposed. Leading explanations identify mechanical trauma to the papillary orifice, hydrostatic injury, and enzymatic injury from activated proteolytic enzymes introduced from the duodenum as potential precipitants for PEP.The mechanical trauma theory proposes that injury to the papillary orifice may cause sphincter of Oddi spasm or edema of the pancreatic orifice, thereby leading to obstruction of pancreatic juice outflow, and promoting pancreatic injury and inflammation. Papillary injury can occur during ERCP by prolonged or repeated attempts at cannulating the pancreatic duct , multiple contrast injections into the pancreatic duct [17], or thermal injury from electrocautery current during sphincterotomy [18].The theory of hydrostatic injury is based on the possibility that overinjection of the pancreat...

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Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled trial

Cited by 68 publications

References 18 publications

Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study

Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study

Can papillary carcinomas be treated by endoscopic ampullectomy?

Post-ERCP Pancreatitis: Mechanisms, Risk Factors, and Prevention

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