THE USEFULNESS OF PROPHYLACTIC TEMPORARY 3F PANCREATIC DUCT STENT TO PREVENT POST-ERCP PANCREATITIS IN PATIENTS WITH BILLROTH II GASTRECTOMY

Aims Biliary cannulation in patients with Billroth II gastrectomy is more difficult than normal anatomy. Difficult cannulation can lead to post-ERCP pancreatitis (PEP). Prophylactic pancreatic stent (PS) can reduce the frequency and severity of PEP. Especially, prophylactic temporary 3F PS placement is known to be effective to reduce PEP with spontaneous stent dislodgment. The aim of this study is to evaluate the effectiveness and spontaneous dislodgement rate of 3F PS in patients with Billroth II gastrectomy comparing with normal anatomy with a difficult biliary cannulation.

Methods Patients with a difficult biliary cannulation underwent 3F PS placement in Billroth II gastrectomy (BIIG group) and normal anatomy (NA group). If the stent had not passed spontaneously by 4 weeks, endoscopic removal of 3F PS was performed. The primary outcome was the incidence and severity of PEP in two groups. Secondary outcome were the rate of spontaneous dislodgment of 3F PS at 7 days, and procedure related adverse events.

Results A total of 34 patients with NA group and 12 of patients with BIIG group underwent 3F PS. The technical success rate of 3F PS placement was 97% in NA group, and 91.6% in BIIG group. The incidence rate of PEP was 9.1% (3/33 mild, 0/33 moderate, 0/33 severe) in NA group and 9.1% (1/11 mild, 0/11 moderate, 0/11 severe) in BIIG group group. Spontaneous stent dislodgement rate within 7 days was 90.9 % in NA group and 36.5 % in BIIG group group. (P=0.001)

Conclusions Prophylactic PS placement in patients with Billroth II may be effective to prevent PEP, but spontaneous dislodgement rate was significantly low comparing with normal anatomy and high rate of 2nd invervention to remove PS.