Feasibility of Temporary Pancreatic Stenting after Early Endoscopic Retrograde Cholangiopancreatography in Patients with Acute Biliary Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: To assess the safety and effectiveness of temporary pancreatic stenting after early endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute biliary pancreatitis regardless of the severity or concomitant cholangitis. METHODS: Temporary pancreatic stenting was performed in 79 patients with visualized pancreatic duct during ERCP. The outcomes of 64 patients with adequate pancreatic stenting (PS) and 15 patients with inadequate pancreatic stenting (no PS) were compared in this prospective, observational trial. RESULTS: The baseline characteristics were similar. Development of systemic inflammatory response syndrome (7.8% for PS vs. 13.3% for no PS; p=0.50) and mortality (none for both groups; p=0.99) did not differ. However, fewer local complications occurred in PS than in no PS (4.7% for PS vs. 20.0% for no PS; p=0.04) and the difference was most outstanding in necrosis (1.6% for PS vs. 13.3% for no PS; p=0.03). CONCLUSIONS: Temporary pancreatic stenting after early ERCP should be considered safe, as complications did not increase even in cases of inadequate stenting. However, if successful, there appears to be a reduction in local complications.

Impact of pancreatic stent as a preventive measure on post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation / 中国内镜杂志

Objective To investigate the impact of pancreatic duct stenting as a preventive measure for post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation.Methods Clinical data of 64 patients with biliary tract disease from January 2008 to December 2015 was prospective analyzed. All the patients were randomly divided into observation group and control group. Patients in observation group received pancreatic stent placement, while patients in control group was not received pancreatic stent placement and nasal duct. Postoperative monitoring items included abdominal pain, blood amylase. Then record and compare the incidence of acute pancreatitis, pancreatitis severity rating, abdominal pain score, Ranson score, amylase recovery time between the two groups.Results Observation group had ifve cases of PEP, the rate was 15.6 %, including mild four cases (12.5 %), medium one case (3.1 %); the control group had 13 cases of PEP, the rate was 40.6 %, including mild six cases (18.8 %), medium four cases (12.5 %), severe three cases (9.4 %). PEP observation group was signiifcantly lower than the control group (P < 0.05). Mild, medium and severe PEP were lower than the control group, in which the severe PEP was signiifcantly lower than the control group (P < 0.05). Ranson score of the observation group was (1.2 ± 0.4), significantly lower than the control group (2.5 ± 1.2) (P < 0.05); the observation group amylase average recovery time was (3.0 ± 0.6) d, it is also signiifcantly lower than the control group (5.8 ± 1.4) d (P < 0.01). No bleeding and perforation complications occurred.Conclusion Pancreatic stenting can effectively prevent the incidence of PEP, reduce postoperative pain, improve patient recovery.

Pancreatic ascites and pleural effusion without pancreatic duct disruption treated with stenting / 대한내과학회지

Pancreatic ascites and pleural effusion is a rare complication of inflammatory disease of pancreas. Disruption of the pancreatic duct secondary to inflammatory pancreatic disease results in an internal pancreatic fistula into the peritoneal or pleural cavities. Thus, pancreatic secretion through the internal pancreatic fistula accumulate within the peritoneal or pleural cavities. The diagnosis is strongly suspected by paracentesis and thoracentesis, which demonstrate a markedly elevated amylase and an albumin level in pancreatic ascites and pleural effusion, and is confirmed by observation of pancreatic duct contrast leakage at endoscopic retrograde pancreatography. We report a patient with pancreatic ascites and pleural effusion who had no demonstrable pancreatic duct disruption on endoscopic retrograde pancreatography, but successfully treated by pancreatic duct stent endoscopically.

The Needle - Knife Sphincterotomy over Pancreatic Stent: A Safe and Effective Technique? / 대한소화기내시경학회지

BACKGROUND/AIMS: Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS. METHODS: Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared.