Year 2016 / Volume 108 / Number 9
Original
Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study

258-562

DOI: 10.17235/reed.2016.4348/2016

David Zagalsky, Martin Alejandro Guidi, Cecilia Curvale, Juan Lasa, Julio de Maria, Hernan Ianniccillo, Hui Jer Hwang, Raúl Matano,

Abstract
Background: The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement. Aim: To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. Materials and methods: This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared. Results: Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered. Conclusion: Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.
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References
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Zagalsky D, Guidi M, Curvale C, Lasa J, de Maria J, Ianniccillo H, et all. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. 4348/2016


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Publication history

Received: 29/03/2016

Accepted: 02/07/2016

Online First: 08/09/2016

Published: 06/09/2016

Article revision time: 92 days

Article Online First time: 163 days

Article editing time: 161 days


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