title: Comparative study of strategies for preventing post-ERCP pancreatitis after early precut sphincterotomy for biliary access.
abstract: OBJECTIVE
  Needle knife precut sphincterotomy (PS) during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with a high risk of post-ERCP pancreatitis (PEP). This study aimed to examine the effect of no prophylaxis, somatostatin, rectal diclofenac and pancreatic duct (PD) stenting in reducing rates of PEP in patients who underwent early PS.
  
  
  METHODS
  This was a retrospective comparative study and the study period was from January 2006 to December 2015. A standardized approach to early PS was used: (i) inadvertent guidewire cannulation of the PD > thrice; (ii) impacted bile duct stone; (iii) inability to achieve deep cannulation within 10 min. PEP prophylactic measures included: (i) none when there was minimal papilla trauma; (ii) somatostatin infusion; (iii) rectal diclofenac; (iv) PD stent. The difference in rates of PEP between the different strategies was analysed.
  
  
  RESULTS
  During the study period, PS was performed in 191 ERCP patients (mean age 66 years; 56.5% males). The ERCP success rate after PS was 93.2% (178/191). Overall the PEP rate was 3.1% (6/191) and the severity in all cases was mild. PEP occurred in 6.1% of patients with PD cannulation but not in those without (P = 0.016). PEP rates were 1.8%, 7.3%, 1.8% and 0% in control, somatostatin, diclofenac and PD stenting groups, respectively (P = 0.209).
  
  
  CONCLUSIONS
  There was no significant difference in PEP rates after early PS whether or not prophylactic measures were adopted if there was minimal papilla trauma. A trend towards lower PEP rates was observed in patients who had either rectal diclofenac or PD stenting, compared to somatostatin.
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: Andrew Boon Eu
authors.initials: AB
authors.lastname: Kwek
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: Mingjun
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: James Weiquan
authors.initials: JW
authors.lastname: Li
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: Prem Harichander
authors.initials: PH
authors.lastname: Thurairajah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013004:Somatostatin / Q000627:therapeutic use; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D015607:Stents
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D013004:Somatostatin
keywords: endoscopic retrograde cholangiopancreatography; endoscopic sphincterotomy; pancreatitis; prophylaxis