PWE-161 Preventing Post-ERCP Pancreatitis (PEP): The Role of Prophylactic Pancreatic Duct Stenting In The Rectal NSAID era

Abstract

Background Rectal non-steroidal anti-inflammatory drug at endoscopic retrograde cholangiopancreatography is now the standard of care to reduce the risk of post-ERCP pancreatitis. Pancreatic duct stenting also reduces the risk of post- ERCP pancreatitis in high-risk patients, but failed pancreatic duct stenting carries an increased PEP rate (up to 35%). Study Aim To assess the impact on post-ERCP pancreatitis of successful and unsuccessful pancreatic duct stent placement in the setting of universal rectal non-steroidal anti-inflammatory drug use. Methods Between 2013–2015, all patients undergoing endoscopic retrograde cholangiopancreatographys in our tertiary referral centre (where rectal non-steroidal anti-inflammatory drugs are used routinely) were included. The electronic patient’s records were reviewed and the following parameters were analysed: indication for pancreatic duct stenting; deployment success; and adverse events. Results A total of 1633 endoscopic retrograde cholangiopancreatographys were performed, and pancreatic duct stenting was attempted in 324 cases (20%), with successful placement in 307 patients (95%). Contra-indications to non-steroidal anti-inflammatory drugs were found in 106 (6.5%) patients. Prophylactic stenting failed in 12 of 213 patients; of whom one patient developed post-ERCP pancreatitis (8%). Eighteen (9%) patients with prophylactic pancreatic duct stents developed post-ERCP pancreatitis compared to 1.4% without prophylactic stents (RR 8.4, p=0.04). Conclusion A lack of difference in post-ERCP pancreatitis in those who underwent successful, and unsuccessful, pancreatic duct stent placement may reflect the protective effect of non-steroidal anti-inflammatory drugs. This data adds to evidence suggesting that pancreatic duct stenting may be less important, even in high-risk patients, with the widespread use of non-steroidal anti-inflammatory drugs.

Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis and the Effect of Octreotide Combined with Nonsteroidal Anti-Inflammatory Drugs on Preventing Its Occurrence

“…Currently, the pathogenesis of post-ERCP pancreatitis remains poorly understood and is generally believed to be directly related with personal factors of patients and surgical procedures, and might be a pathological consequence caused by infection, mechanical and chemical injuries, etc. The specific mechanism is demonstrated to be as follows: duodenal papilla edema, bile reflux, and Oddi sphincter spasm occur due to various factors, resulting in increased pressure in pancreatic ducts, abnormal secretion of pancreatic enzyme, and large aggregation of zymogen granules in acinar cells plus their fusion with lysosomes, eventually activating pancreatin zymogen in advance, and leading to damage to pancreatic parenchyma [13,14].…”

Methods for prevention of acute post-endoscopic retrograde cholangiopancreatography pancreatitis

“…The 3 Fr stents were shown to be associated with lower rates of PEP and pancreatic duct disruption, compared to 5 Fr stents [12]. On the other hand, a study published in 2017 suggested no additional benefit of stenting as compared to the use of intra-rectal NSAID suppositories in the prevention of PEP in high-risk patients [13].…”

Modern Tactics of Endoscopic Treatment of Pancreatobiliary System Diseases

“…Ендоскопічна ретроградна холангіопанкреатографія (ЕРХПГ) набуває все більшого поширення в лікуванні захворювань жовчовивідних шляхів та підшлункової залози [1,2]. Вивчення лікувальнодіагностичних можливостей ЕРХПГ та ускладнень, які супроводжують цей метод, дозволило переглянути показання та протипоказання до його використання, основними з яких є видалення конкрементів з жовчовивідних протоків та проведення стентування в разі обтурації протоків новоутвореннями як самих протоків, так і прилеглих тканин [2][3][4]. До окремого великого розділу роботи зараховуємо хронічні панкреатити, що супроводжуються формуванням кіст підшлункової залози та стриктур вірсунгової протоки, які виникають внаслідок перенесеного панкреонекрозу.…”