title: Systematic pancreatic stenting after endoscopic snare papillectomy may reduce the risk of postinterventional pancreatitis.
abstract: BACKGROUND
  Pancreatitis is the most feared complication of endoscopic papillectomy (EP). Prevention by pancreatic duct stenting following EP has been advocated but not proven by a randomized trial. The purpose of the present retrospective review is to compare a period of systematic stenting with the period before in which stents were placed selectively.
  
  
  METHODS
  A total of 107 patients undergoing EP from February 1999 to December 2009 were retrospectively reviewed. After an initial period with selective stenting (dilated duct, previous pancreatitis) between 1999 and 2002 (n = 24, group 1), stents were placed routinely after EP unless pancreas divisum was diagnosed (2002-2009; n = 83, group 2) to reduce postpapillectomy acute pancreatitis (PAP). PAP rates defined by Consensus Criteria were compared in the two periods.
  
  
  RESULTS
  Five patients in group 1 were selected to receive a pancreatic stent (21%); in group 2 stenting was successful in 75 of 78 patients (success rate 96%) without pancreas divisum (n = 5). Overall, PAP occurred in 11% of patients. PAP rate was significantly reduced after introduction of systematic pancreatic stenting (5 vs 25%; p = 0.01) and occurred less often in stented than in nonstented patients: (5% (4/80) vs 27% (6/22), p = 0.0019). PAP also occurred in one of five patients with pancreas divisum. Selective stenting of patients also was an independent risk factor for PAP (OR 13, p = 0.001) in a multivariate analysis.
  
  
  CONCLUSIONS
  Attempts at systematic stenting after EP pancreatic stenting appears to prevent PAP. Results should be corroborated by a randomized trial.
authors.affiliation: Department of Gastroenterology, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008 Lyon, France. dr.napoleon@wanadoo.fr
authors.forename: Bertrand
authors.initials: B
authors.lastname: Napoléon
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Alvarez-Sanchez
authors.forename: Philippe
authors.initials: P
authors.lastname: Leclercq
authors.forename: François
authors.initials: F
authors.lastname: Mion
authors.forename: Jean
authors.initials: J
authors.lastname: Pialat
authors.forename: Rodica
authors.initials: R
authors.lastname: Gincul
authors.forename: Daniel
authors.initials: D
authors.lastname: Ribeiro
authors.forename: Marie
authors.initials: M
authors.lastname: Cambou
authors.forename: Christine
authors.initials: C
authors.lastname: Lefort
authors.forename: Mar
authors.initials: M
authors.lastname: Rodríguez-Girondo
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Scoazec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010195:Pancreatitis / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
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