Retrospective Study
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World J Gastroenterol. Jul 14, 2014; 20(26): 8617-8623
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8617
Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation
Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
Kazunari Nakahara, Chiaki Okuse, Keigo Suetani, Yosuke Michikawa, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Shinjiro Kobayashi, Takehito Otsubo, Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Author contributions: Nakahara K and Okuse C contributed equally to this work; Nakahara K and Okuse C designed the report; Nakahara K, Suetani K, Michikawa Y, and Kobayashi S were attending doctors for the patients; Otsubo T and Itoh F organized the report; and Nakahara K wrote the paper.
Correspondence to: Kazunari Nakahara, PhD, Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan. nakahara@marianna-u.ac.jp
Telephone: +81-44-9778111 Fax: +81-44-9765805
Received: January 11, 2014
Revised: March 10, 2014
Accepted: April 21, 2014
Published online: July 14, 2014
Processing time: 184 Days and 2.4 Hours
Abstract

AIM: To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation.

METHODS: Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW.

RESULTS: No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP.

CONCLUSION: In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.

Keywords: Pancreatic stenting; Pancreatic guidewire placement; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Endoscopic sphincterotomy; Endoscopic retrograde cholangiopancreatography

Core tip: We retrospectively examined the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation in whom the bile duct was cannulated using the pancreatic duct guidewire placement method (P-GW). The incidences of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) were 4.2% and 29.0% in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). A multivariate analysis identified the absence of pancreatic stenting as a significant risk factor for PEP. Therefore, in patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.