Comparison of early precut of pancreatic duct sphincter and pancreatic duct stenting placement in the prevention of pancreatitis after ERCP_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAO Jie ¹ , YAO Chunhe ² , FU Jinkun ² , WANG Xiaoliang ² , YANG Xue ¹ , LI Yu ¹ ,  SUN Hao ¹

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, P. R. China;
2. Department of Hepatobiliary Surgery, Xianyang Hospital of Yan’an University, Xianyang 712000, P. R. China;

Corresponding author：

SUN Hao, Email: sunhaoxjyf@126.com

Keywords：

post-endoscopic retrograde cholangiopancreatography pancreatitis; early precut of pancreatic duct sphincter; pancreatic duct stenting

DOI：

10.7507/1007-9424.201801042

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Objective To compare the difference in efficacy of early precut of pancreatic duct sphincter and pancreatic duct stent placement in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) during high-risk patients. Methods A prospective study was conducted on 61 eligible patients who underwent ERCP treatment in Department of Hepatobiliary Surgery of The First Affiliated Hospital of Xi’an Jiaotong University and Xianyang Hospital of Yan’an University, from November 2016 to November 2017. All cases were randomly divided into early pancreatic sphincterotomy group (n=30) and pancreatic duct stenting group (n=31) . The success rate of intubation, intubation, and incidence of complication were compared. Results There was no significant difference in the success rate of the first intubation between the 2 groups (P=0.580), but the intubation time of the early pancreatic sphincterotomy group was shorter than that of the pancreatic duct stenting group (P=0.007). In the early pancreatic sphincterotomy group, there was 1 case of post-ERCP pancreatitis, 1 case of biliary tract infection, and 1 case of postoperative bleeding. In the pancreatic duct stenting group, there was 1 case of post-ERCP pancreatitis, and 2 cases of biliary tract infection. No severe complications such as perforation or severe acute pancreatitis occurred in both 2 groups. There was no significant difference in the incidence of total complications and specified complication (included post-ERCP pancreatitis, biliary tract infection, and postoperative bleeding) between the 2 groups (P>0.05). Conclusions Thereis no significant difference in the incidence of postoperative pancreatitis after early precut of pancreatic duct sphincter and pancreatic duct stenting placement in patients with high-risk, but intubation time of early precut of pancreatic duct sphincter method is shorter than the pancreatic duct stenting placement method.

Citation： TAO Jie, YAO Chunhe, FU Jinkun, WANG Xiaoliang, YANG Xue, LI Yu, SUN Hao. Comparison of early precut of pancreatic duct sphincter and pancreatic duct stenting placement in the prevention of pancreatitis after ERCP. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(8): 954-958. doi: 10.7507/1007-9424.201801042 Copy

1.	郭学刚, 罗辉, 郑亮. ERCP术后胰腺炎的预防策略. 中国实用外科杂志, 2017, 37(8): 853-860.
2.	Wang AY. Medications and methods for the prevention of post-ERCP pancreatitis. Gastroenterol Hepatol (N Y), 2017, 13(3): 188-191.
3.	Mazaki T, Mado K, Masuda H, et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol, 2014, 49(2): 343-355.
4.	Sriram PV, Rao GV, Nageshwar Reddy D. The precut-when, where and how? A review. Endoscopy, 2003, 35(8): S24-S30.
5.	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(12): 1235-1240.
6.	Cennamo V, Fuccio L, Zagari RM, et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy, 2010, 42(5): 381-388.
7.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
8.	Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol, 2001, 96(2): 417-423.
9.	Elmunzer BJ. Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc, 2017, 29(7): 749-757.
10.	卢静, 王春晖, 钟显飞. 经内镜逆行胰胆管造影术后胰腺炎预防进展. 华西医学, 2017, ? (2): 262-266.
11.	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(1): 80-88.
12.	庞勇, 张炳印, 田伏洲, 等. 四步渐进法在ERCP困难插管教学中的应用. 中国普外基础与临床杂志, 2014, 21(6): 769-771.
13.	李汛, 朱晓亮, 周文策, 等. 经内镜胰管支架置入在预防ERCP术后胰腺炎高危患者中的临床应用. 中国普外基础与临床杂志, 2010, 17(10): 1006-1009.
14.	Luo H, Zhao L, Leung J, et al. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial. Lancet, 2016, 387(10035): 2293-2301.
15.	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(15): 1414-1422.
16.	Buxbaum J, Yu CY. Indomethacin and lactated Ringer's hydration to prevent post-ERCP pancreatitis: right combination but wrong volume. Gastrointest Endosc, 2017, 86(5): 925-926.
17.	Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med, 1996, 335(13): 909-918.
18.	Ayoubi M, Sansoè G, Leone N, et al. Comparison between needle-knife fistulotomy and standard cannulation in ERCP. World J Gastrointest Endosc, 2012, 4(9): 398-404.
19.	郭学刚, 吴开春. 内镜逆行胰胆管造影. 北京: 人民军医出版社, 2015: 112-113.
20.	Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy, 2007, 39(9): 793-801.
21.	Chahal P, Tarnasky PR, Petersen BT, et al. Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol, 2009, 7(8): 834-839.
22.	Smith MT, Sherman S, Ikenberry SO, et al. Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc, 1996, 44(3): 268-275.
23.	葛祥丽, 毛涛, 孙学国, 等. 内镜下逆行胰胆管造影术尽早经胰管括约肌预切开的安全性. 世界华人消化杂志, 2014, ?(8): 1166-1170.
24.	郭宇廷, 诚谊, 朱海涛, 等. 十二指乳头括约肌预切开术在困难插管内镜逆行胰胆管造影术中的应用. 中华腔镜外科杂志: 电子版, 2014, 7(4) : 275-279.
25.	金上博, 刘益民, 贺继东, 等. 胰管导丝占据法与经胆胰管隔膜预切开法在胆总管结石患者困难性内镜下逆行胰胆管造影中的应用. 中国内镜杂志, 2016, 22(12): 75-78.
26.	Zagalsky D, Guidi MA, Curvale C, et al. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. Rev Esp Enferm Dig, 2016, 108(9): 258-562.
27.	中华医学会消化内镜分会ERCP学组. ERCP诊治指南 (2010版). 中华消化内镜杂志, 2010, 27(3): 113-118.

1. 郭学刚, 罗辉, 郑亮. ERCP术后胰腺炎的预防策略. 中国实用外科杂志, 2017, 37(8): 853-860.
2. Wang AY. Medications and methods for the prevention of post-ERCP pancreatitis. Gastroenterol Hepatol (N Y), 2017, 13(3): 188-191.
3. Mazaki T, Mado K, Masuda H, et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol, 2014, 49(2): 343-355.
4. Sriram PV, Rao GV, Nageshwar Reddy D. The precut-when, where and how? A review. Endoscopy, 2003, 35(8): S24-S30.
5. 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(12): 1235-1240.
6. Cennamo V, Fuccio L, Zagari RM, et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy, 2010, 42(5): 381-388.
7. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
8. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol, 2001, 96(2): 417-423.
9. Elmunzer BJ. Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc, 2017, 29(7): 749-757.
10. 卢静, 王春晖, 钟显飞. 经内镜逆行胰胆管造影术后胰腺炎预防进展. 华西医学, 2017, ? (2): 262-266.
11. 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(1): 80-88.
12. 庞勇, 张炳印, 田伏洲, 等. 四步渐进法在ERCP困难插管教学中的应用. 中国普外基础与临床杂志, 2014, 21(6): 769-771.
13. 李汛, 朱晓亮, 周文策, 等. 经内镜胰管支架置入在预防ERCP术后胰腺炎高危患者中的临床应用. 中国普外基础与临床杂志, 2010, 17(10): 1006-1009.
14. Luo H, Zhao L, Leung J, et al. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial. Lancet, 2016, 387(10035): 2293-2301.
15. 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(15): 1414-1422.
16. Buxbaum J, Yu CY. Indomethacin and lactated Ringer's hydration to prevent post-ERCP pancreatitis: right combination but wrong volume. Gastrointest Endosc, 2017, 86(5): 925-926.
17. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med, 1996, 335(13): 909-918.
18. Ayoubi M, Sansoè G, Leone N, et al. Comparison between needle-knife fistulotomy and standard cannulation in ERCP. World J Gastrointest Endosc, 2012, 4(9): 398-404.
19. 郭学刚, 吴开春. 内镜逆行胰胆管造影. 北京: 人民军医出版社, 2015: 112-113.
20. Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy, 2007, 39(9): 793-801.
21. Chahal P, Tarnasky PR, Petersen BT, et al. Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol, 2009, 7(8): 834-839.
22. Smith MT, Sherman S, Ikenberry SO, et al. Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc, 1996, 44(3): 268-275.
23. 葛祥丽, 毛涛, 孙学国, 等. 内镜下逆行胰胆管造影术尽早经胰管括约肌预切开的安全性. 世界华人消化杂志, 2014, ?(8): 1166-1170.
24. 郭宇廷, 诚谊, 朱海涛, 等. 十二指乳头括约肌预切开术在困难插管内镜逆行胰胆管造影术中的应用. 中华腔镜外科杂志: 电子版, 2014, 7(4) : 275-279.
25. 金上博, 刘益民, 贺继东, 等. 胰管导丝占据法与经胆胰管隔膜预切开法在胆总管结石患者困难性内镜下逆行胰胆管造影中的应用. 中国内镜杂志, 2016, 22(12): 75-78.
26. Zagalsky D, Guidi MA, Curvale C, et al. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. Rev Esp Enferm Dig, 2016, 108(9): 258-562.
27. 中华医学会消化内镜分会ERCP学组. ERCP诊治指南 (2010版). 中华消化内镜杂志, 2010, 27(3): 113-118.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of early precut of pancreatic duct sphincter and pancreatic duct stenting placement in the prevention of pancreatitis after ERCP

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