Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

doi:10.3748/wjg.v24.i22.2392

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World Journal of Gastroenterology

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World J Gastroenterol. Jun 14, 2018; 24(22): 2392-2399
Published online Jun 14, 2018. doi: 10.3748/wjg.v24.i22.2392

Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Takuto Hikichi, Hiromasa Ohira

Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Hiromasa Ohira, Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan

Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan

Author contributions: Sugimoto M designed and performed the study; Sugimoto M, Takagi T, and Ohira H analyzed the data; Sugimoto M, Takagi T, and Ohira H wrote the paper; Suzuki R, Konno N, Asama H, Sato Y, Irie H, Watanabe K, Nakamura J, Kikuchi H, Waragai Y, Takasumi M and Hikichi T provided clinical advice; Hikichi T and Ohira H supervised the study.

Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Fukushima Medical University.

Conflict-of-interest statement: We have no financial relationships to disclose.

Data sharing statement: No additional data are available.

Correspondence to: Tadayuki Takagi, MD, PhD, Associate Professor, Doctor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan. daccho@fmu.ac.jp

Telephone: +81-24-5471202 Fax: +81-24-5472055

Received: February 27, 2018
Peer-review started: February 27, 2018
First decision: March 9, 2018
Revised: March 29, 2018
Accepted: May 5, 2018
Article in press: May 5, 2018
Published online: June 14, 2018
Processing time: 103 Days and 23.1 Hours

Abstract

AIM

To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS

Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups.

RESULTS

Pancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086) vs 78.5 (5.0-1266.5), P = 0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia (≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis.

CONCLUSION

Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

Keywords: Pancreatic stent; Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Post-endoscopic retrograde cholangiopancreatography hyperamylasemia; Pancreatic body or tail

Core tip: We investigated whether the location of the inserted pancreatic stent rather than pancreatic stent length influenced the frequency of post-endoscopic retrograde cholangiopancreatography (ERCP) hyperamylasemia and post-ERCP pancreatitis (PEP). Pancreatic amylase isoenzyme levels after ERCP were significantly higher in the head group than in the body/tail group. PEP did not occur in the body/tail group. Stent insertion into the pancreatic head was an independent risk factor for hyperamylasemia after ERCP, while stent insertion up to the pancreatic body or tail reduced the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.