Year 2017 / Volume 109 / Number 3
Original
Post-ERCP pancreatitis: early precut or pancreatic duct stent? A multicenter, randomized-controlled trial and cost-effectiveness analysis

174-179

DOI: 10.17235/reed.2017.4565/2016

Hui Jer Hwang, Martín Alejandro Guidi, Cecilia Curvale, Juan Lasa, Raúl Matano,

Abstract
ABSTRACT Background: Pancreatitis is the most frequent complication due to ERCP. Pancreatic duct stent placement has been described as a preventive measure. There is also evidence pointing towards the preventive effect that early precut may provide. Aim: To determine and compare the cost-effectiveness of an early precut approach versus pancreatic duct stent placement for the prevention of post-ERCP pancreatitis. Methods: This was a multicenter, randomized-controlled pilot study with a cost-effectiveness analysis performed between early precut (group A) and pancreatic duct stent (group B) for the prevention of pancreatitis in high-risk patients. Patients with a difficult biliary cannulation and at least one other risk factor for post-ERCP pancreatitis were enrolled and randomized to one of the treatment arms. Both effectiveness and costs of the procedures and their complications were analyzed and compared. Results: From November 2011 to November 2013, 101 patients were enrolled; 50 subjects were assigned to group A and 51 to group B. There were no significant differences in terms of baseline characteristics of patients between groups. Two cases of mild pancreatitis were observed in each group. The overall costs were U$ 1,242.6 per patient in group A and U$ 1,606.5 per patient in group B. The cost in group B was 29.3% higher (p < 0.0001). Conclusion: Early precut showed a better cost-effectiveness profile when compared to pancreatic duct stent placement.
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References
1- Cotton PB, Garrow DA, Gallagher J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11 497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-8.
2- Loperfido S, Angelini G, Benedetti G, et al. Major early compliations from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10.
3- Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-23.
4- Vandervoot J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652-6.
5- Elmunzer BJ, Scheiman JM, Lehman GA, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414-22.
6- Fazel A, Quadri A, Catalano MF, et al. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc 2003; 57: 291-4.
7- Smithline A, Silverman W, Rogers D, et al. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy induced pancreatitis in high-risk patients. Gastrointest Endosc 1993; 39: 652-7.
8- Sofuni A, Maguchi H, Itoi T, et al. Prophylaxis of post-ERCP pancreatitis by an endoscopic pancreatic spontaneus dislodgement stent. Clin Gastroenterol Hepatol 2007; 5: 1339-46.
9- Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998; 115: 1518-24.
10- Ito K, Fujita N, Noda Y, et al. Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial. J Gastroenterol 2010; 45: 1183-91.
11- Sofuni A, Maguchi H, Mukai T, et al. Endoscopic pancreatic duct stents reduce the incidence of post-ERCP pancreatitis in high-risk patients. Clin Gastroenterol Hepatol 2011; 9: 851-8.
12- Mazaki T, Mado K, Masuda H, et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol 2014; 49: 343-355.
13- Das A, Singh P, Sivak M, et al. Pancreatic stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointest Endosc 2007; 65: 960-968
14- Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc 2005; 61: 112-125.
15- Shakoor T, Geenen JE. Pre-cut papillotomy. Gastrointest Endosc 1992; 38: 623-627.
16- Larkin CJ, Huibregtse K. Precut sphincterotomy: indications, pitfalls, and complications. Curr Gastroenterol Rep 2001; 3: 147-153.
17- Tang SJ, Haber GB, Kortan P, et al. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy 2005; 37: 58-65.
18- Sriram PV, Rao GV, Nageshwar RD. The precut – when, where and how? A review. Endoscopy 2003; 35: S24-S30.
19- Cennamo V, Fuccio L, Repici A, et al. Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective randomized comparative study. Gastrointest Endosc 2009; 69: 473-479.
20- de Weerth A, Seitz U, Zhong y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy 2006; 38: 1235-1240.
21- Cennamo V, Fuccio L, Zagari RM, et al. Can early precut implementation reduce ERCP related complication risk? Meta-analysis of randomized controlled trials. Endoscopy 2010; 42: 381-388.
22-
23- Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383-393.
24- ASGE Standards of Practice Committee. Complications of ERCP. Gastrointest Endosc 2012;75(3):467-473.
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Hwang H, Guidi M, Curvale C, Lasa J, Matano R. Post-ERCP pancreatitis: early precut or pancreatic duct stent? A multicenter, randomized-controlled trial and cost-effectiveness analysis. 4565/2016


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Publication history

Received: 01/08/2016

Accepted: 22/12/2016

Online First: 10/02/2017

Published: 28/02/2017

Article revision time: 118 days

Article Online First time: 193 days

Article editing time: 211 days


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