title: Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: better overall outcome with adequate pancreatic drainage.
abstract: OBJECTIVE
  To analyze the efficacy of pancreatic duct (PD) stenting following endoscopic sphincterotomy (EST) compared with EST alone in reducing complication rate and improving overall outcome in acute biliary pancreatitis (ABP).
  
  
  METHODS
  Between 1 January 2009 and 1 July 2010, 141 nonalcoholic patients with clinical, laboratory and imaging evidence of ABP were enrolled. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 h from the onset of pain. Seventy patients underwent successful ERCP, EST, and stone extraction (control group); 71 patients (PD stent group) had EST, stone extraction and small-caliber (5 Fr, 3-5 cm) pancreatic stent insertion. All patients were hospitalized for medical therapy and jejunal feeding and were followed up.
  
  
  RESULTS
  The mean age, Glasgow score, symptom to ERCP time, mean amylase and CRP levels at initial presentation were not significantly different in the PD stent group compared to the control group: 60.6 vs. 64.3, 3.21 vs. 3.27, 34.4 vs. 40.2, 2446.9 vs. 2114.3, 121.1 vs. 152.4, respectively. Complications (admission to intensive care unit, pancreatic necrosis with septicemia, large (>6 cm) pseudocyst formation, need for surgical necrosectomy) were less frequent in the PD stent group resulting in a significantly lower overall complication rate (9.86% vs. 31.43%, p < 0.002). Mortality rates (0% vs. 4.28%) were comparable, reasonably low and without any significant differences.
  
  
  CONCLUSIONS
  Temporary small-caliber PD stent placement may offer sufficient drainage to reverse the process of ABP. Combined with EST the process results in a significantly less complication rate and better clinical outcome compared with EST alone during the early course of ABP.
authors.affiliation: Bács-Kiskun County Hospital, Kecskemét, Teaching Hospital of the University of Szeged, Kecskemet, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Dubravcsik
authors.forename: István
authors.initials: I
authors.lastname: Hritz
authors.forename: Roland
authors.initials: R
authors.lastname: Fejes
authors.forename: Gábor
authors.initials: G
authors.lastname: Balogh
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Virányi
authors.forename: Péter
authors.initials: P
authors.lastname: Hausinger
authors.forename: András
authors.initials: A
authors.lastname: Székely
authors.forename: Attila
authors.initials: A
authors.lastname: Szepes
authors.forename: László
authors.initials: L
authors.lastname: Madácsy
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000401:mortality; D003131:Combined Modality Therapy; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000401:mortality; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult