Further studies are needed on urgent ERCP with pancreatic stent placement or replacement for salvage of post-ERCP pancreatitis

We read with great interest the article by Kerdsirichairat et al. on urgent endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement or replacement for salvage of post-ERCP pancreatitis (PEP) [1]. The authors presented their experience of treating or preventing early PEP by using urgent salvage ERCP with de novo pancreatic stent placement or replacement. However, we have some comments as follows.

First, a total of 57 patients with PEP were included in the study but only 14 patients received intervention with salvage stent placement. Could the authors have randomized or divided the 57 patients into two groups and then compared the strategy of early intervention with conservative management? Second, we would like to know whether the patients who accepted salvage stenting also required additional conservative management. Finally, the cost-effectiveness of salvage stenting also requires investigation. We believe that prospective randomized studies are still required to evaluate the efficacy of urgent ERCP with pancreatic stent placement or replacement for salvage of PEP.

• Reference

• 1 Kerdsirichairat T, Attam R, Arain M et al. Urgent ERCP with pancreatic stent placement or replacement for salvage of post-ERCP pancreatitis. Endoscopy 2014; In press. DOI: 10.1055/s-0034-1377750.