Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis by an Endoscopic Pancreatic Spontaneous Dislodgement Stent

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doi:10.1016/j.cgh.2007.07.008 Original article—liver, pancreas, and biliary tract

Prophylaxis of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis by an Endoscopic Pancreatic Spontaneous Dislodgement Stent

Atsushi Sofuni, Hiroyuki Maguchi‡, Takao Itoi, Akio Katanuma‡, Hiroyuki Hisai§, Teitetsu Niido¶, Masayuki Toyota, Tsuneshi Fujii#, Youji Harada¶ and Tadanori Takada

Background & Aims: Pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is the most common and potentially serious complication of ERCP. The frequency of post-ERCP pancreatitis generally is reported to be between 1% and 9%. One cause of pancreatitis is retention of pancreatic juice resulting from papilledema after the procedure. We conducted a randomized controlled multicenter study to evaluate whether placement of a temporary pancreatic stent designed for spontaneous dislodgement prevents post-ERCP pancreatitis.

Methods: The subjects were 201 consecutive patients who underwent ERCP. The patients were randomized into the stent placement group (S group = 98) or the nonstent placement group (nS group = 103). The stent used was 5F in diameter, 3 cm in length, straight, and unflanged inside.

Results: Stents were placed successfully in 96% of the S group, and spontaneous stent dislodgment was recognized in 95.7% of those. The mean duration to dislodgment was 2 days, and there were no severe complications. The overall frequency of post-ERCP pancreatitis was 8.5%. The frequency of post-ERCP pancreatitis in the S and nS groups was 3.2% and 13.6%, respectively, showing a significantly lower frequency in the S group (P = .019). The mean increase in amylase level in the pancreatitis patients was significantly higher in the nS group (P = .014).

Conclusions: The randomized controlled multicenter trial showed that placement of a pancreatic spontaneous dislodgment stent significantly reduces post-ERCP pancreatitis.

Abbreviations: ERCP, endoscopic retrograde cholangiopancreatography; nS group, nonstent placement group; PS, pancreatic duct stent; PSDS, pancreatic spontaneous dislodgement stent; S group, stent placement group

Address requests for reprints to: Atsushi Sofuni, MD, PhD, Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjyuku-ku, Tokyo, 160-0023 Japan. fax: (81) 3-5381-6654.

Clinical Gastroenterology and Hepatology Volume 5, Issue 11, November 2007, Pages 1339-1346