Early Pancreatic Duct Stent Removal in Preventing Post-endoscopic Pancreatitis
Early Pancreatic Duct Stent Removal in Preventing Post-endoscopic Pancreatitis
Temporary pancreatic duct stent placement during endoscopic retrograde
 cholangiopancreatography (ERCP) has been recommended for post-endoscopic pancreatitis (PEP)
 prophylaxis in high risk patients, including those in whom accidental pancreatic duct
 cannulation has occurred. However, the optimal duration of stent placement remains an open
 question. The investigators aim is to assess if immediate stent removal is effective in the
 prevention of PEP after accidental pancreatic duct cannulation.
Recent meta-analyses of randomized controlled trials confirmed that pancreatic stent
 placement after ERCP reduces the risk of PEP but the optimal duration of stent placement
 remains an open question. It has been suggested that in truly high-risk patients the
 pancreatic stent must be left in place for a minimum of 24 hours or more whereas in patients
 at lesser risk pancreatic duct drainage probably only needs to be maintained for a few hours
 or less. Leaving the stent in place at the end of the ERCP procedure carries the disadvantage
 of radiological follow-up until spontaneous dislodgment occurs or endoscopic removal is
 deemed timely; moreover, proximal migration has been reported, requiring endoscopic or even
 surgical removal. There is a paucity of data comparing immediate removal with spontaneous
 dislodgment in high-risk patients. In one study, significantly higher rates of PEP were
 detected in patients in whom a pancreatic stent was removed immediately at the end of the
 ERCP procedure than in those in whom the stent was left in place: unfortunately, only
 patients undergoing a precut sphincterotomy were evaluated in that study which was published
 only in abstract form. Therefore, it is still uncertain whether leaving a stent in place is
 more effective than immediate removal in preventing PEP in high-risk patients.
Inclusion Criteria:

 -  All patients in whom accidental pancreatic duct cannulation had occurred

 -  during guide wire directed ERCP

 Exclusion Criteria:

 -  Patients who had undergone previous endoscopic papillectomy or sphincterotomy

 -  and those with an indwelled nasobiliary or nasopancreatic tube