Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study.
BACKGROUND
The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement.


OBJECTIVE
To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography.


METHODS
This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared.


RESULTS
Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered.


CONCLUSIONS
Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.
Endoscopia, Hospital Posadas.
David
D
Zagalsky
Gastroenterologia, Hospital El Cruce, Argentina.
Martin Alejandro
MA
Guidi
Gastroenterologia, Hospital en red El Cruce, Argentina.
Cecilia
C
Curvale
Endoscopia, Hospital Posadas.
Juan
J
Lasa
Gastroenterologia, Hospital El Cruce.
Julio
J
de Maria
Endoscopia, Hospital Posadas.
Hernan
H
Ianniccillo
Gastroenterologia, Hospital El Cruce.
Hui Jer
HJ
Hwang
Gastroenterologia, Hospital El Cruce.
Raúl
R
Matano
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D012306:Risk; D016037:Single-Blind Method; D046628:Sphincter of Oddi Dysfunction / Q000150:complications / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*