title: Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial.
abstract: BACKGROUND
  Pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography (ERCP) has been recommended in patients at risk for post-ERCP pancreatitis. However, the optimal duration of stent placement remains an open question. Our aim was to compare the efficacy of pancreatic stenting for the duration of ERCP only with spontaneous dislodgment/deferred endoscopic removal in preventing post-ERCP pancreatitis after accidental wire-guided pancreatic duct cannulation.
  
  
  METHODS
  All patients in whom accidental wire-guided pancreatic duct cannulation had occurred during ERCP underwent immediate 5-Fr unflanged pigtail pancreatic duct stenting before attempting any other endoscopic maneuver. At the end of the ERCP, patients were randomly assigned to immediate stent removal (group A) or to leaving the stent in place (group B). Assessment of post-ERCP pancreatitis was blind.
  
  
  RESULTS
  Post-ERCP pancreatitis occurred in 6/21 (29 %) patients in group A and in 0/19 patients in group B (P = 0.021); the two groups were well matched for their baseline characteristics. Post-ERCP pancreatitis was mild in two patients, moderate in two patients, and severe in two patients. Stents dislodged spontaneously in 14/19 (74 %) patients within 24-96 h; uneventful endoscopic removal was carried out after 96 h in 5 cases. Proximal stent migration did not occur in any case.
  
  
  CONCLUSIONS
  Pancreatic duct stent placement for the duration of ERCP only does not prevent post-ERCP pancreatitis. Pancreatic stents should be left in place until spontaneous dislodgment occurs or endoscopic removal is deemed timely. 5-Fr unflanged pigtail stents remain in place for a period sufficient to prevent post-ERCP pancreatitis and do not migrate proximally.
authors.affiliation: Gastroenterologia ed Endoscopia Digestiva, Nuovo Ospedale S. Agostino-Estense, Viale Giardini 1355, 41100 Modena, Italy. r.conigliaro@ausl.mo.it
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.forename: Mauro
authors.initials: M
authors.lastname: Manno
authors.forename: Carmelo
authors.initials: C
authors.lastname: Barbera
authors.forename: Angelo
authors.initials: A
authors.lastname: Caruso
authors.forename: Giampiero
authors.initials: G
authors.lastname: Olivetti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Melotti
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D015607:Stents