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.	郭學剛, 羅輝, 鄭亮. ERCP術后胰腺炎的預防策略. 中國實用外科雜志, 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.	盧靜, 王春暉, 鐘顯飛. 經內鏡逆行胰膽管造影術后胰腺炎預防進展. 華西醫學, 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.	龐勇, 張炳印, 田伏洲, 等. 四步漸進法在ERCP困難插管教學中的應用. 中國普外基礎與臨床雜志, 2014, 21(6): 769-771.
13.	李汛, 朱曉亮, 周文策, 等. 經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用. 中國普外基礎與臨床雜志, 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.	郭學剛, 吳開春. 內鏡逆行胰膽管造影. 北京: 人民軍醫出版社, 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.	葛祥麗, 毛濤, 孫學國, 等. 內鏡下逆行胰膽管造影術盡早經胰管括約肌預切開的安全性. 世界華人消化雜志, 2014, ?(8): 1166-1170.
24.	郭宇廷, 誠誼, 朱海濤, 等. 十二指乳頭括約肌預切開術在困難插管內鏡逆行胰膽管造影術中的應用. 中華腔鏡外科雜志: 電子版, 2014, 7(4) : 275-279.
25.	金上博, 劉益民, 賀繼東, 等. 胰管導絲占據法與經膽胰管隔膜預切開法在膽總管結石患者困難性內鏡下逆行胰膽管造影中的應用. 中國內鏡雜志, 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.	中華醫學會消化內鏡分會ERCP學組. ERCP診治指南 (2010版). 中華消化內鏡雜志, 2010, 27(3): 113-118.

1. 郭學剛, 羅輝, 鄭亮. ERCP術后胰腺炎的預防策略. 中國實用外科雜志, 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. 盧靜, 王春暉, 鐘顯飛. 經內鏡逆行胰膽管造影術后胰腺炎預防進展. 華西醫學, 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. 龐勇, 張炳印, 田伏洲, 等. 四步漸進法在ERCP困難插管教學中的應用. 中國普外基礎與臨床雜志, 2014, 21(6): 769-771.
13. 李汛, 朱曉亮, 周文策, 等. 經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用. 中國普外基礎與臨床雜志, 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. 郭學剛, 吳開春. 內鏡逆行胰膽管造影. 北京: 人民軍醫出版社, 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. 葛祥麗, 毛濤, 孫學國, 等. 內鏡下逆行胰膽管造影術盡早經胰管括約肌預切開的安全性. 世界華人消化雜志, 2014, ?(8): 1166-1170.
24. 郭宇廷, 誠誼, 朱海濤, 等. 十二指乳頭括約肌預切開術在困難插管內鏡逆行胰膽管造影術中的應用. 中華腔鏡外科雜志: 電子版, 2014, 7(4) : 275-279.
25. 金上博, 劉益民, 賀繼東, 等. 胰管導絲占據法與經膽胰管隔膜預切開法在膽總管結石患者困難性內鏡下逆行胰膽管造影中的應用. 中國內鏡雜志, 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. 中華醫學會消化內鏡分會ERCP學組. ERCP診治指南 (2010版). 中華消化內鏡雜志, 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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