The safety and utility of prophylactic pancreatic duct stents in the prevention of post-ERCP pancreatitis: an analysis of practice in a single UK tertiary referral center

Kennedy, Patrick; Russo, Evangelos; Kumar, Naveenta; Powell, Nick; Bansi, Devinder S.; Thillainayagam, Andrew V.; Vlavianos, Panagiotis; Westaby, David

doi:10.1007/s00464-009-0875-7

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…In addition, there was a reduction in mild and moderate pancreatitis but not severe pancreatitis. This is in contrast to other studies in which pancreatic duct stent placement virtually eliminated severe PEP [7,8]. Although a variety of adverse events related to pancreatic duct stents are listed in the article by Mazaki et al [6], many are probably not direct effects of pancreatic duct stent placement but due instead to the procedure itself.…”

mentioning

confidence: 79%

Pancreatic stent placement for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: do we need further evidence? No, the defense rests

Rao¹,

Baron²

2010

Endoscopy

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Editorial 870The exact mechanisms that contribute to the development of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have not been fully elucidated. However, several factors are known to promote PEP, the most important of which appears to be manipulations of the ampulla, which result in decreased outflow of secretions through the main pancreatic duct, either by inducing sphincter of Oddi spasm or by causing mechanical obstruction by edema formation. The latter concept is supported by data suggesting that a patent minor papilla in the absence of pancreas divisum is protective against PEP [1], presumably because pancreatic drainage can be sustained in the face of relative obstruction at the level of the major papilla. Thus, the idea of placing a temporary pancreatic duct stent to prevent PEP is supported by its role in maintaining the integrity of pancreatic outflow. The concept that stent placement in the pancreatic duct may reduce the risk of PEP was introduced in the early 1990s [2], and the first randomized trial to demonstrate its efficacy was shown by Tarnasky et al. [3] in patients with known or suspected sphincter of Oddi dysfunction (SOD), a group deemed to be at especially high risk for PEP due to increased pancreatic duct sphincter hypertension. Since that time a number of studies have shown that pancreatic duct stents are effective in preventing PEP, not only in patients with SOD but also in a subset of individuals found to be at high risk for PEP due to one of the following technical risk factors: difficult biliary cannulation, multiple pancreatic duct injections, precut sphincterotomy (particularly when the cut involves the papillary orifice), pancreatic duct sphincterotomy (both major and minor, the latter in the setting of pancreas divisum), pancreatic duct brush cytology, balloon dilation of the papilla for stone extraction (without biliary sphincterotomy), and endoscopic ampullectomy.Temporary pancreatic duct stent placement for prevention of PEP in high risk patients is recommended by ERCP experts and has been included as a grade A recommendation in a 2010 guideline for PEP prophylaxis by the European Society of Gastrointestinal Endoscopy [4]. Thus, it appears that the practice of pancreatic duct stent placement is now firmly accepted in the academic domain although there remains a discrepancy as it has yet to gain widespread acceptance in the community [5]. The question remains: do we still need more evidence? In this month's issue of Endoscopy, Mazaki et al. [6] publish the latest systematic review and meta-analysis of randomized controlled trials evaluating pancreatic duct stent placement vs. no stent placement for PEP prophylaxis. Eight studies were identified involving a total of 680 patients, 336 of whom had a pancreatic duct stent placed. The majority of patients were deemed to be at high risk although two studies enrolled patients who were not considered high risk by most criteria. Overall, 19 % in the no-stent group developed PEP compared with only 6 % in...

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confidence: 79%

Pancreatic stent placement for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: do we need further evidence? No, the defense rests

Rao¹,

Baron²

2010

Endoscopy

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“…Documents regarding the benefits of PD stent GMJ.2015;4(2):67-71 www.gmj.ir in reducing post-ERCP pancreatitis are increasing. In this context, some case control studies revealed that PD stent insertion considerably reduced the incidence of post-ER-CP pancreatitis certainly among high-risk patients [1,4,8,10,13]. On the other hand, other studies revealed opposite results [2].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Ajdarkosh

Hemasi

Zamani

et al. 2015

GMJ

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Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]

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“…In two casecontrolled trials (42,43) and one retrospective analysis (44), pancreatic stent placement decreased the incidence of PEP. In one survey, the PEP rate did not decrease with stent placement, but moderate and severe pancreatitis were seen less often in patients in whom a stent was inserted (45). In a meta-analysis (46) of five controlled studies, PEP incidence was found to be one-third lower in patients in whom a stent was inserted compared to patients with no stent insertion (5.8% vs. 15.5%; p=0.001).…”

Section: Mechanical Reduction Of Pressure In the Pancreatic Duct -Panmentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Sarıtaş¹,

Üstündağ

Baron

2011

Turk J Gastroenterol

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The safety and utility of prophylactic pancreatic duct stents in the prevention of post-ERCP pancreatitis: an analysis of practice in a single UK tertiary referral center

Cited by 9 publications

References 19 publications

Pancreatic stent placement for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: do we need further evidence? No, the defense rests

Pancreatic stent placement for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: do we need further evidence? No, the defense rests

Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Prevention of post-ERCP pancreatitis

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