title: What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis.
abstract: BACKGROUND
  Conducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis.
  
  
  METHODS
  The clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis.
  
  
  RESULTS
  In 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30 min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08).
  
  
  CONCLUSIONS
  Patients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takenaka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fujita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Masuda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Maki
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sanuki
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hayakumo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kutsumi
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
keywords: Pancreatic duct stent; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Propensity score analysis