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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(07): E860-E868
DOI: 10.1055/a-0886-6384
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Pancreatic stenting to prevent post-ERCP pancreatitis: a randomized multicenter trial

Veit Phillip
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Aldis Pukitis
2   Pauls Stradins Clinical University Hospital, Center of Gastroenterology, Hepatology and Nutrition, Riga, Latvia
,
Alexey Epstein
3   First Clinical Hospital named after E.E. Volosevich, Arkhangelsk, Russia
,
Alexander Hapfelmeier
4   Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
David Haf
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Miriam Schwab
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Ihsan Ekin Demir
5   Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Jonas Rosendahl
6   Klinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
,
Albrecht Hoffmeister
6   Klinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
,
Roland M. Schmid
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Andreas Weber
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Hana Algül
1   Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
› Author Affiliations
Further Information

Publication History

submitted 04 September 2018

accepted after revision 29 January 2019

Publication Date:
03 July 2019 (online)

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Prevention of post-ERCP pancreatitis: NSAID or pancreatic stent or both?Endosc Int Open 2019; 07(07): E869-E870
DOI: 10.1055/a-0889-7796

Abstract

Background and study aims Acute pancreatitis (AP) is one of the most common gastrointestinal disorders leading to hospitalization and the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Besides pharmaco-prophylaxis, pancreatic stenting has been demonstrated to protect from post-ERCP pancreatitis (PEP). However, it remains unclear which patients benefit from pancreatic stenting. We therefore hypothesized that in an unselected population, inadvertent cannulation of the pancreatic duct during first-time ERCP increases risk of PEP and that this risk can be significantly reduced by pancreatic stenting.

Patients and methods This study was a multicenter, prospective, randomized controlled trial conducted at four European centers. A total of 167 patients undergoing first-time ERCP were enrolled in this trial. In the case of inadvertent cannulation of the pancreatic duct, patients were randomly assigned to receive either a 5 French plastic pancreatic stent of various length or no routine prophylactic intervention for PEP.

Results A total of 167 patients were included in the final analysis. Prophylactic stent insertion significantly reduced the rate of PEP during first-time ERCP (odds ratio 0.43; 95% confidence interval 0.19 – 0.98; P = 0.04). The number needed to treat to prevent one case of PEP by prophylactic stent insertion after inadvertent cannulation of the pancreatic duct was 8.1 for the intention-to-treat population.

Conclusion In an unselected patient population, inadvertent cannulation of the pancreatic duct during first-time ERCP is associated with a high risk for PEP. This risk can be significantly reduced by prophylactic pancreatic stenting, which is a safe and feasible procedure.

 

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