Prophylactic Pancreatic Duct Stenting in Acute Necrotizing Pancreatitis
Prophylactic Pancreatic Duct Stenting in Acute Necrotizing Pancreatitis
Since the majority of patients with necrotizing pancreatitis will experience a leak from the
 pancreatic duct during their course of disease resulting in intra- and peripancreatic fluid
 collections, it is reasonable to hypothesize that placement of a ductal stent may prevent
 some of the late complications and morbidity associated with pancreatic necrosis. This
 prospective, randomized, controlled multicenter trial investigates the role of early
 prophylactic ductal stenting in acute necrotizing pancreatitis.

 The purpose of the study is to determinate the safety and feasibility of early prophylactic
 pancreatic duct stenting in necrotizing pancreatitis in reducing complications, length of
 stay in hospital and in in-tensive care unit compared to the traditional treatment.
Inclusion Criteria:

 In patients with suspected necrotizing pancreatitis a pancreatic protocol 3-phase contrast
 enhanced (CE) CT shall be performed. Since a very early CT may underestimate the extent of
 pancreatic necro-sis, it is recommended to wait at least 72 hours after the onset of
 symptoms before CT is done. The CECT may be repeated if the initial CT shows no necroses
 and the clinical course continues to indicate a severe case.

 MRI may be used instead of CT in case of contraindication to intravenous contrast due to
 renal failure.

 If CECT reveals pancreatic necrosis affecting the head, neck, or body of pancreas and the
 necrosis is suspected to include the main pancreatic duct an informed consent to
 participate in the study is ob-tained, after which the patient will be randomized to either
 a) the control group with traditional treat-ment (i.e. at the discretion of each
 participating center) or to b) the intervention group with same treatment as in the control
 group plus ERP and PD-stenting. Patients with isolated necrosis of the tail will not be
 included in the study.

 Exclusion Criteria:

 All consecutive patients (age between 18-75 years) admitted to the participating centers
 for acute pan-creatitis with an area of non-enhancing pancreatic parenchyma on CT believed
 to represent necrosis are prospectively enrolled in the study. At initial presentation the
 age, gender, etiology of the pancreatitis, clinical and laboratory findings will be
 recorded. Patients with malignancies and patients from whom an informed consent to
 participate in the study cannot be obtained will be excluded.

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