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Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial

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Abstract

Background

Pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography (ERCP) has been recommended in patients at risk for post-ERCP pancreatitis. However, the optimal duration of stent placement remains an open question. Our aim was to compare the efficacy of pancreatic stenting for the duration of ERCP only with spontaneous dislodgment/deferred endoscopic removal in preventing post-ERCP pancreatitis after accidental wire-guided pancreatic duct cannulation.

Methods

All patients in whom accidental wire-guided pancreatic duct cannulation had occurred during ERCP underwent immediate 5-Fr unflanged pigtail pancreatic duct stenting before attempting any other endoscopic maneuver. At the end of the ERCP, patients were randomly assigned to immediate stent removal (group A) or to leaving the stent in place (group B). Assessment of post-ERCP pancreatitis was blind.

Results

Post-ERCP pancreatitis occurred in 6/21 (29 %) patients in group A and in 0/19 patients in group B (P = 0.021); the two groups were well matched for their baseline characteristics. Post-ERCP pancreatitis was mild in two patients, moderate in two patients, and severe in two patients. Stents dislodged spontaneously in 14/19 (74 %) patients within 24–96 h; uneventful endoscopic removal was carried out after 96 h in 5 cases. Proximal stent migration did not occur in any case.

Conclusions

Pancreatic duct stent placement for the duration of ERCP only does not prevent post-ERCP pancreatitis. Pancreatic stents should be left in place until spontaneous dislodgment occurs or endoscopic removal is deemed timely. 5-Fr unflanged pigtail stents remain in place for a period sufficient to prevent post-ERCP pancreatitis and do not migrate proximally.

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Acknowledgments

The present study was conducted without any financial support.

Disclosures

Rita Conigliaro, Raffaele Manta, Helga Bertani, Mauro Manno, Carmelo Barbera, Angelo Caruso, Giampiero Olivetti, Gianluigi Melotti, and Marzio Frazzoni have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Gastroenterologia ed Endoscopia Digestiva, Nuovo Ospedale S. Agostino-Estense, Viale Giardini 1355, 41100, Modena, Italy

    Rita Conigliaro, Raffaele Manta, Helga Bertani, Mauro Manno, Carmelo Barbera, Angelo Caruso & Giampiero Olivetti

  2. Chirurgia Generale, Nuovo Ospedale S. Agostino-Estense, Viale Giardini 1355, 41100, Modena, Italy

    Gianluigi Melotti

  3. Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino-Estense, Viale Giardini 1355, 41100, Modena, Italy

    Marzio Frazzoni

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  1. Rita Conigliaro
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  2. Raffaele Manta
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  3. Helga Bertani
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  5. Carmelo Barbera
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  6. Angelo Caruso
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  7. Giampiero Olivetti
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  8. Gianluigi Melotti
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  9. Marzio Frazzoni
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Correspondence to Rita Conigliaro.

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Conigliaro, R., Manta, R., Bertani, H. et al. Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial. Surg Endosc 27, 569–574 (2013). https://doi.org/10.1007/s00464-012-2487-x

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  • DOI: https://doi.org/10.1007/s00464-012-2487-x

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