TITLE

PROPHYLACTIC PANCREATIC DUCT STENTING IN PATIENTS WITH SUSPECTED SPHINCTER OF ODDI DYSFUNCTION BUT NORMAL SPHINCTER OF ODDI MANOMETRY

AUTHOR(S)
Prasad, P.; Varadarajulu, S.; Foody, W.; Sabol, D.; Rawls, E.; Payne, M.; Hawes, R.; Cotton, P.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA78
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Although post-ERCP pancreatitis is a well recognised complication among patients with sphincter of Oddi dysfunction (SOD), preliminary data suggest that the rate of pancreatitis could be as high as 10% to 15% even among patients suspected to have SOD but have normal sphincter of Oddi manometry (SOM) studies. The aim of this study is to determine if placement of a temporary pancreatic stent in patients with suspected SOD but normal SOM reduces pancreatitis rates. Methods: Evaluation of all patients who underwent ERCP for suspected SOD but had a normal SOM study (both biliary and pancreatic) over a 4 year period (1998-2002). If SOM was normal (basal sphincter pressure < 40 mm Hg), the decision to place a temporary, 3 Fr, single pig-tail pancreatic stent (Wilson-Cook, Winston-Salem, NC) was made by the individual endoscopist. Patients who underwent any therapeutic intervention, such as stent extraction or orifice dilation, during the same setting were excluded from the study. Post-ERCP pancreatitis was defined as per standard consensus criteria. Abdominal x ray was done routinely after 14 days to verify spontaneous stent passage. Results: A total of 147 patients with normal biliary and pancreatic manometry studies were identified from the ERCP database. The rate of post-ERCP pancreatitis was 0% (0/26) among patients who underwent prophylactic pancreatic stenting compared to 10.7% (13/121) among those who were not stented. No pancreatic stent induced complications were encountered. Conclusions: Routine temporary pancreatic duct stenting appears to decrease the rate and severity of pancreatitis among patients suspected to have SOD but have normal SOM studies. The procedure appears safe. A randomised controlled trial is warranted to confirm these findings.
ACCESSION #
9747809

 

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