Rescue ERCP and a small caliber pancreatic stent insertion to prevent the evolution of severe post-ercp pancreatitis – a case series

Madácsy, László; Kurucsai, G.; Gódi, Szilárd; Fejes, R; Joó, I; Székely, A

doi:10.1055/s-2008-1079663

Cited by 4 publications

(4 citation statements)

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“…PEP should be managed according to existing Guidelines. Salvage pancreatic stenting has been proposed for highly selected patients with PEP (severe pain, more than 10-fold elevation of serum amylase, rise of white blood cells and C-reactive protein values); results in two uncontrolled studies (20 patients) were promising in spite of challenging pancreatic stenting because of duodenal edema [227,228]. These data should be considered very carefully until large RCTs are available.…”

Section: Post-ercp Pancreatitismentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.

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Section: Post-ercp Pancreatitismentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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“…There are some other tools that can be used to prevent PEP, such as the use of pancreatic prostheses in patients with repeated cannulations or opacification of the Wirsung duct (16)(17)(18)(19). In the patients who present abdominal pain in the post-ERC period, the rescue ERC being performed by installing a Wirsung prosthesis could reduce the severity of PEP (20)(21)(22). We do not use these tools routinely, but we are starting a protocol to evaluate their effectiveness in our center.…”

Section: Discussionmentioning

confidence: 99%

Rectal diclofenac for prevention of post-endoscopic retrograde cholangiography pancreatitis

Losada¹,

Martin²,

Troncoso³

et al. 2021

Ann Palliat Med

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Background: Acute pancreatitis is an important complication of endoscopic retrograde cholangiography (ERC), occurring between 1-10% of patients. Several randomized controlled trials and meta-analyses have demonstrated the effectiveness of nonsteroidal anti-inflammatories (NSAIDs) such as diclofenac and indomethacin as a post-ERC pancreatitis (PEP) prophylaxis. The aim is to determine if the rectal diclofenac use reduces the PEP rate. Methods: Retrospective cohort study. Subjects were included who underwent ERC for different indications in a tertiary center between January 2015 and June 2016. Two groups were analyzed: group A (without diclofenac use) and group B (with use of diclofenac as PEP prophylaxis). Biodemographic, technical and mortality variables were measured.Results: The total cohort was 116 patients, 67 in group A and 49 in group B. The average age was 61.9±17.8 and 58.3±15.8 years, respectively (P=0.2606). Gender distribution showed a women predominance in both groups (P=0.933). Of the technical variables measured, the precut showed a statistically significant relationship to PEP (P=0.013). Of the total cohort, 8.6% developed acute pancreatitis after an ERC: four in group A and six in group B (P=0.196). In those who developed PEP (n=10), six patients developed severe acute pancreatitis (SAP). The average hospitalization for PEP was 32.2±34 days (P=0.881). No patients died, not were there any adverse reactions to the drug. Conclusions:Rectal diclofenac administered at the beginning of the ERC did not reduce the PEP rate in this patients cohort.

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“…[19][20][21] Rescue MPD stenting has been reported to prevent the evolution of pancreatitis, and should be done 8-20 hours from the onset of PEP. [22][23][24] Stents used for MPD stenting should be short (less then 5 cm, and small in diameter (5 French) and distally unflanged plastic stents. Unflanged stents can lead to spontaneous migration into the gastrointestinal tract, that occurs in 95% of cases within 10 days.…”

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confidence: 99%

How to Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Boškoski

Costamagna

2020

Gastroenterology

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Rescue ERCP and a small caliber pancreatic stent insertion to prevent the evolution of severe post-ercp pancreatitis – a case series

Cited by 4 publications

References 0 publications

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Rectal diclofenac for prevention of post-endoscopic retrograde cholangiography pancreatitis

How to Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

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