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

Veit Phillip; Aldis Pukitis; Alexey Epstein; Alexander Hapfelmeier; David Haf; Miriam Schwab; Ihsan Ekin Demir; Jonas Rosendahl; Albrecht Hoffmeister; Roland M. Schmid; Andreas Weber; Hana Algül

doi:10.1055/a-0886-6384

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(07): E860-E868
DOI: 10.1055/a-0886-6384

Original article

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

Veit Phillip

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Aldis Pukitis

²Pauls Stradins Clinical University Hospital, Center of Gastroenterology, Hepatology and Nutrition, Riga, Latvia

,

Alexey Epstein

³First Clinical Hospital named after E.E. Volosevich, Arkhangelsk, Russia

,

Alexander Hapfelmeier

⁴Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

David Haf

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Miriam Schwab

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Ihsan Ekin Demir

⁵Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Jonas Rosendahl

⁶Klinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany

,

Albrecht Hoffmeister

⁶Klinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany

,

Roland M. Schmid

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Andreas Weber

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

,

Hana Algül

¹Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany

› Author Affiliations

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.

Full Text

References

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