A comparative study of strategies for prevention of post-ERCP pancreatitis after early pre-cut sphincterotomy for biliary access

Abstract

Objectives

Needle knife precut sphincterotomy (PS) during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with a higher risk of post-ERCP pancreatitis (PEP). This study examined the effect of no prophylaxis, somatostatin, rectal diclofenac and pancreatic duct (PD) stenting in reducing the rates of PEP in patients who underwent early PS.

Methods

The study period was January 2006 to December 2015. A standardized approach to early PS was used: 1) inadvertent guidewire cannulation of PD > 3 times; 2) impacted bile duct stone; 3) inability to achieve deep cannulation within 10 minutes. PEP prophylactic measures included: 1) none when there was minimal papilla trauma; 2) somatostatin infusion; 3) rectal diclofenac; 4) PD stent. The difference in rates of PEP between the different strategies was analysed.

Results

During the study period, PS was performed in 191/2879 ERCP (mean age 66 years; 56.5% males). ERCP success rate after PS was 178/191 (93.2%). Overall the PEP rate was 6/191 (3.1%) and the severity was mild in all cases. PEP occurred in 6.1% of patients with PD cannulation but not in those without (p = 0.016). PEP rates were 1/57 (1.8%) in control, 4/55 (7.3%) with somatostatin, 1/55 (1.8%) with diclofenac and 0 with PD stent (p = 0.209).

Conclusions

There was no significant difference in PEP rates after early PS whether or not prophylactic measures were adopted if there was minimal papilla trauma. A trend towards lower PEP rates was observed in patients who had either rectal diclofenac or PD stenting, compared to somatostatin.

from #Esophageal Cancer via a.lsfakia on Inoreader http://ift.tt/2bWVb9i
via IFTTT