Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects: A randomized study

• David Zagalsky ^[2] ; Martín Guidi ^[1] ; Cecilia Curvale ^[1] ; Juan Lasa ^[2] ; Julio de María ^[1] ; Hernán Ianniccillo ^[2] ; Hui Jer Hwang ^[1] ; Raúl Matano ^[1]
  1. [1] Hospital El Cruce

     Hospital El Cruce

     Argentina

     
  2. [2] Hospital Nacional Prof. A. Posadas. Buenos Aires, Argentina
• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 108, Nº. 9, 2016, págs. 558-562
• Idioma: inglés
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• Resumen

  • 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.