Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
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.
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.
