Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Takuto Hikichi, Hiromasa Ohira, Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Takuto Hikichi, Hiromasa Ohira

Abstract

Aim: To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

Methods: Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups.

Results: Pancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086) vs 78.5 (5.0-1266.5), P = 0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia (≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis.

Conclusion: Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatic body or tail; Pancreatic stent; Post-endoscopic retrograde cholangiopancreatography hyperamylasemia; Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Conflict of interest statement

Conflict-of-interest statement: We have no financial relationships to disclose.

Figures

Figure 1
Figure 1
Subjects in this study. A total of 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted at our hospital between January 2007 and November 2017. Among these patients, 147 who received ERCP primarily for biliary investigation and had a stent inserted to prevent post-ERCP pancreatitis were included in this study. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). ERCP: Endoscopic retrograde cholangiopancreatography.
Figure 2
Figure 2
Inserted pancreatic stent. A: A pancreatic stent (Geenen 5 Fr, 5 cm) was inserted into the pancreatic head; B: A pancreatic stent (Geenen 5 Fr, 7 cm) passed the angle between the pancreatic head and body and was inserted up to the pancreatic body or tail.

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Source: PubMed

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