Early Precut Versus Pancreatic Stent for Post-ERCP Pancreatitis
Early Precut Versus Pancreatic Stent for Post-ERCP Pancreatitis
BACKGROUND: The most common complication of endoscopic retrograde cholangiopancreatography
 (ERCP) is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. However,
 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 ERCP.

 MATERIALS AND METHODS: This is a single-blinded, randomized trial that took place in two
 tertiary referral centers in Buenos Aires. ERCP subjects shall present at least one of the
 following risk factors: female sex, age less than 40 years, clinical suspicion of Sphincter
 of Oddi dysfunction, previous pancreatitis, common bile duct diameter of less than 8 mm. Only
 those who present a difficult biliary cannulation shall be randomized into two groups: those
 who receive early precut sphincterotomy or those in whom persistency of biliary cannulation
 is intended with subsequent pancreatic duct stent placement after cholangiography is
 achieved. The incidence of post-ERCP pancreatitis as well as other complications shall be
 compared.
It is well known that pancreatitis is the most common and dreadful complication of endoscopic
 retrograde cholangiopancreatography (ERCP). Historically, precut sphincterotomy has been
 regarded as a risk factor for post-ERCP pancreatitis. However, some evidence has suggested
 that if used at an early point during the procedure, it may actually behave as a protective
 factor.

 In high risk patients, such as those patients with sphincter of Oddi dysfunction, pancreatic
 duct stent placement has been considered to be a prophylactic measure against pancreatitis.
 However, pancreatic duct stent placement can sometimes be a cumbersome procedure, and may
 require additional procedures (mainly if spontaneous stent dislodgment is not accomplished).
 There is no evidence comparing early precut versus pancreatic duct stent placement in
 high-risk patients.

 As a consequence, the aim of this study was to compare the efficacy of early precut
 sphincterotomy versus pancreatic duct stent placement in patients presenting at least one
 risk factor for post-ERCP pancreatitis and difficult biliary cannulation.

 A single-blinded, randomized trial was undertaken. Patients fulfilling inclusion criteria who
 presented with difficult biliary cannulation during ERCP were randomized to early precut or
 persistence in biliary cannulation with a sphincterotome with posterior pancreatic duct stent
 placement. The incidence of post-ERCP pancreatitis as well as other complications were
 compared between groups.
Inclusion Criteria:

 -  Subjects with in need for ERCP due to benign or malignant biliopancreatic conditions,
 with at least one of the following features:

 -  female sex

 -  age less than 40 years

 -  clinical suspicion of Sphincter of Oddi Dysfunction

 -  previous pancreatitis

 -  common bile duct diameter of less than 8 mm

 -  Subjects with difficult biliary cannulation, as defined by previously published
 criteria

 Exclusion Criteria:

 -  patients with contrast allergy

 -  pregnant women

 -  patients unable to sign informed consent