title: The safety and utility of pancreatic duct stents in the emergency ERCP of acute biliary pancreatitis but difficult sphincterotomy.
abstract: OBJECTIVE
  The aims of this study were to assess the feasibility and safety of emergency ERCP and pancreatic duct (PD) stenting in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy proved difficult, and to compare the clinical outcome of those patients having emergency ERCP without pancreatic stent.
  
  
  METHODS
  One hundred and ninety-one consecutive patients with ABP were included in this study. Patients were randomly assigned to either the stent group (n=78) or the no-stent group (n=113). In the stent group, 3-5Fr,5-7cm-long pancreatic stent insertion was initially applied and removed endoscopically 1-2 weeks post-ER-CP. All patients were hospitalized for medical therapy and were followed-up.
  
  
  RESULTS
  Mean age, initial symptom-to-ERCP times, Glasgow severity scores and peak amylase and CRP levels at initial presentation were not significantly different in the stent group vs. the no-stent group, and the selective biliary cannulation was achieved in 80% of the stent group and in 94% of the no-stent group (p=0.15). More importantly, the complication rate was significantly lower in the stent group (7.7% vs. 31.9%). There was no difference in mortality between the two groups statistically(1.3% vs. 3.5%).
  
  
  CONCLUSIONS
  Pancreatic duct stent-ing is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP, show better outcomes as compared to no-stent group. It is recommended to reduce the incidence of the complication in the emergency ERCP of ABP but difficult sphincterotomy. However, further prospective trials are needed.
authors.affiliation: Tianjin Medical University, Tianjin, China. dingguoqian@126.com
authors.forename: Guoqian
authors.initials: G
authors.lastname: Ding
authors.forename: Mingfang
authors.initials: M
authors.lastname: Qin
authors.forename: Wang
authors.initials: W
authors.lastname: Cai
authors.forename: Fusheng
authors.initials: F
authors.lastname: Zou
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000401:mortality; D015607:Stents; D016896:Treatment Outcome