title: Feasibility and safety of emergency ERCP and small-caliber pancreatic stenting as a bridging procedure in patients with acute biliary pancreatitis but difficult sphincterotomy.
abstract: BACKGROUND
  The aims of the present study were: (1) to assess the feasibility and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct (PD) stenting with small-caliber stents as a bridging procedure in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy (EST) proved difficult, failed or was contraindicated, and (2) to compare the clinical outcome of those patients having emergency ERCP with and without pancreatic stent.
  
  
  METHODS
  Eighty-seven consecutive patients with ABP were referred for emergency ERCP. In 60 of these ABP patients, ERCP, EST, and stone extraction (if necessary) were performed without PD stenting. In the remaining 27 patients, small-caliber (3-5 F, 4 cm) pancreatic stent insertion was initially applied. All patients were hospitalized for medical therapy and were followed up.
  
  
  RESULTS
  The mean ages, the initial symptom-to-ERCP times, the Glasgow severity scores, and the peak amylase and CRP levels at initial presentation were not significantly different in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group. More importantly, the complication rate was significantly lower in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group (7.4% vs. 25%); while the mortality rates (0% vs. 6.7%) were comparable, reasonably low, and demonstrated no statistically significant differences.
  
  
  CONCLUSIONS
  Temporary PD stenting with small-caliber stents is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP and serve as a bridging procedure in severe ABP in patients with failed, complicated, or contraindicated biliary EST.
authors.affiliation: Department of Gastroenterology and Endoscopy Unit, Fejér Megyei Szent György Hospital, Seregélyesi 3, Székesfehérvár, 8000, Hungary.
authors.forename: Roland
authors.initials: R
authors.lastname: Fejes
authors.forename: Gábor
authors.initials: G
authors.lastname: Kurucsai
authors.forename: András
authors.initials: A
authors.lastname: Székely
authors.forename: Iván
authors.initials: I
authors.lastname: Székely
authors.forename: Aron
authors.initials: A
authors.lastname: Altorjay
authors.forename: László
authors.initials: L
authors.lastname: Madácsy
mesh_terms: D000208:Acute Disease; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D016037:Single-Blind Method; D016717:Sphincterotomy, Endoscopic; D015607:Stents