Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results.
BACKGROUND
Placement of a pancreatic duct (PD) stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication.


OBJECTIVE
Our purpose was to determine whether PD stent placement reduces pancreatitis rates in this patient population.


METHODS
Non-randomized, retrospective study.


METHODS
Large, tertiary referral center.


METHODS
From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated.


METHODS
PD stent placement.


METHODS
Pancreatitis rates.


RESULTS
A total of 403 patients were available for analysis: 169 had a PD stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 (P= .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 (P< .001), the incidence of risk factors for pancreatitis, trainee participation, or prior sphincter therapy was similar between the 2 groups. In patients with an intact papilla, stent placement reduced the rate of pancreatitis from 11.5% to 2.7% (P= .012). In patients with prior sphincter therapy, no benefit was seen from stent placement, although there was a trend to decreased pancreatitis rates in stented patients with prior pancreatobiliary sphincterotomy.


CONCLUSIONS
Nonrandomized, retrospective design.


CONCLUSIONS
Temporary PD stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.
Saad
Abdo M
AM
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Fogel
Evan L
EL
McHenry
Lee
L
Watkins
James L
JL
Sherman
Stuart
S
Lazzell-Pannell
Laura
L
Lehman
Glen A
GA
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008365:Manometry; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D046628:Sphincter of Oddi Dysfunction / Q000150:complications*; D015607:Stents; D013997:Time Factors