Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: Better overall outcome with adequate pancreatic drainage

Zsolt Dubravcsik, István Hritz, Roland Fejes, Gábor Balogh, Zsolt Virányi, Péter Hausinger, András Székely, Attila Szepes, László Madácsy

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To analyze the efficacy of pancreatic duct (PD) stenting following endoscopic sphincterotomy (EST) compared with EST alone in reducing complication rate and improving overall outcome in acute biliary pancreatitis (ABP). Methods: Between 1 January 2009 and 1 July 2010, 141 nonalcoholic patients with clinical, laboratory and imaging evidence of ABP were enrolled. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 h from the onset of pain. Seventy patients underwent successful ERCP, EST, and stone extraction (control group); 71 patients (PD stent group) had EST, stone extraction and small-caliber (5 Fr, 3-5 cm) pancreatic stent insertion. All patients were hospitalized for medical therapy and jejunal feeding and were followed up. Results: The mean age, Glasgow score, symptom to ERCP time, mean amylase and CRP levels at initial presentation were not significantly different in the PD stent group compared to the control group: 60.6 vs. 64.3, 3.21 vs. 3.27, 34.4 vs. 40.2, 2446.9 vs. 2114.3, 121.1 vs. 152.4, respectively. Complications (admission to intensive care unit, pancreatic necrosis with septicemia, large (>6 cm) pseudocyst formation, need for surgical necrosectomy) were less frequent in the PD stent group resulting in a significantly lower overall complication rate (9.86% vs. 31.43%, p < 0.002). Mortality rates (0% vs. 4.28%) were comparable, reasonably low and without any significant differences. Conclusions: Temporary small-caliber PD stent placement may offer sufficient drainage to reverse the process of ABP. Combined with EST the process results in a significantly less complication rate and better clinical outcome compared with EST alone during the early course of ABP.

Original languageEnglish
Pages (from-to)729-736
Number of pages8
JournalScandinavian journal of gastroenterology
Volume47
Issue number6
DOIs
Publication statusPublished - Jun 1 2012

Keywords

  • Clinical trial
  • ERCP
  • acute biliary pancreatitis
  • biliary-clinical
  • complications
  • endoscopic sphincterotomy
  • pancreas-clinical
  • pancreatic stent

ASJC Scopus subject areas

  • Gastroenterology

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