title: Endoscopic pancreatic duct stents reduce the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients.
abstract: OBJECTIVE
  Pancreatitis is the most common and potentially serious complication of post-endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is caused mostly by postprocedural papillary edema and retention of pancreatic juice. We conducted a randomized controlled trial to determine whether placement of a temporary-type, pancreatic duct stent prevents PEP and to identify risk factors for PEP.
  
  
  METHODS
  We analyzed data from 426 consecutive patients who underwent ERCP-related procedures at 37 endoscopic units. The patients were assigned randomly to groups that received stents (S group, n = 213) or did not (nS group, n = 213). The stent used was temporary, 5F in diameter, 3 cm long, and straight with an unflanged inner end.
  
  
  RESULTS
  The overall frequency of PEP was 11.3%. The frequencies of PEP in the S and nS groups were 7.9% and 15.2%, respectively; the lower incidence of PEP in the S group was statistically significant based on the full analysis set (P = .021), although there was no statistically significant differences in an intention-to-treat analysis (P = .076). There were significant differences in PEP incidence between groups in multivariate analysis for the following risk factors: pancreatography first, nonplacement of a pancreatic duct stent after ERCP, procedure time of 30 minutes or more, sampling of pancreatic tissue by any method, intraductal ultrasonography, and difficulty of cannulation (≥15 min). Patients with more than 3 risk factors had a significantly greater incidence of pancreatitis.
  
  
  CONCLUSIONS
  Placement of a pancreatic duct stent reduces the incidence of PEP. Several risk factors are associated with PEP.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. a-sofuni@amy.hi-ho.ne.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Shinji
authors.initials: S
authors.lastname: Okaniwa
authors.forename: Masataka
authors.initials: M
authors.lastname: Kikuyama
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kutsumi
authors.forename: Keiji
authors.initials: K
authors.lastname: Hanada
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ueki
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology* / Q000517:prevention & control*; D015607:Stents; D016896:Treatment Outcome