title: Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study.
abstract: BACKGROUND
  Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCP. Difficult biliary cannulation can be a procedure-related risk factor for PEP. Recent studies reported that a prophylactic pancreatic stent (PS) can reduce the frequency and severity of PEP.
  
  
  OBJECTIVE
  To evaluate the efficacy and usefulness of a temporary 3F PS to prevent PEP in patients with difficult biliary cannulations.
  
  
  METHODS
  A multicenter, prospective, randomized study.
  
  
  METHODS
  Two tertiary-care academic medical centers.
  
  
  METHODS
  In total, 101 patients with a difficult biliary cannulation were randomly divided into the 3F PS placement group (PS group, n = 50) or the nonstent (NS) group (NS group, n = 51).
  
  
  METHODS
  Endoscopic placement of a 3F unflanged PS.
  
  
  METHODS
  The incidence and severity of PEP in the 2 groups, spontaneous dislodgment of stents, and procedure-related complications.
  
  
  RESULTS
  The technical success rate of 3F PS placement was 96% (48/50). The lengths of the stents were 4 cm (n = 21), 6 cm (n = 15), and 8 cm (n = 12). Spontaneous stent dislodgment within 7 days occurred in 94% of patients (45/48). The mean duration until spontaneous dislodgment was 3.5 days. The incidence rate of PEP was 12% (6/50: mild, 5; moderate, 1) in the PS group and 29.4% (15/51: mild, 12; moderate, 2; severe, 1) in the NS group. Severe pancreatitis occurred in only 1 patient in the NS group. In a multivariate analysis, prophylactic placement of PS was the only prophylactic factor for PEP (odds ratio, 0.126; 95% CI, 0.025-0.632, P = .012).
  
  
  CONCLUSIONS
  No comparative results for stent size and diameter and a low-risk cohort group.
  
  
  CONCLUSIONS
  Prophylactic temporary 3F PS placement in patients with a difficult biliary cannulation during ERCP seems to be a safe and effective method for reducing PEP and results in a high rate of spontaneous passage of stents without complications.
authors: Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Cheonan, South Korea.
authors: Tae Hoon
authors: TH
authors: Lee
authors: Jong Ho
authors: JH
authors: Moon
authors: Hyun Jong
authors: HJ
authors: Choi
authors: Seung Hyo
authors: SH
authors: Han
authors: Young Koog
authors: YK
authors: Cheon
authors: Young Deok
authors: YD
authors: Cho
authors: Sang-Heum
authors: SH
authors: Park
authors: Sun-Joo
authors: SJ
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D015607:Stents; D055815:Young Adult