title: Post-ERCP pancreatitis: early precut or pancreatic duct stent? A multicenter, randomized-controlled trial and cost-effectiveness analysis.
abstract: BACKGROUND
  Pancreatitis is the most frequent complication due to ERCP. Pancreatic duct stent placement has been described as a preventive measure. There is also evidence pointing towards the preventive effect that early precut may provide.
  
  
  OBJECTIVE
  To determine and compare the cost-effectiveness of an early precut approach versus pancreatic duct stent placement for the prevention of post-ERCP pancreatitis.
  
  
  METHODS
  This was a multicenter, randomized-controlled pilot study with a cost-effectiveness analysis performed between early precut (group A) and pancreatic duct stent (group B) for the prevention of pancreatitis in high-risk patients. Patients with a difficult biliary cannulation and at least one other risk factor for post-ERCP pancreatitis were enrolled and randomized to one of the treatment arms. Both effectiveness and costs of the procedures and their complications were analyzed and compared.
  
  
  RESULTS
  From November 2011 to November 2013, 101 patients were enrolled; 50 subjects were assigned to group A and 51 to group B. There were no significant differences in terms of baseline characteristics of patients between groups. Two cases of mild pancreatitis were observed in each group. The overall costs were U$ 1,242.6 per patient in group A and U$ 1,606.5 per patient in group B. The cost in group B was 29.3% higher (p < 0.0001).
  
  
  CONCLUSIONS
  Early precut showed a better cost-effectiveness profile when compared to pancreatic duct stent placement.
authors.affiliation: Gastroenterología, Hospital El Cruce.
authors.forename: Hui Jer
authors.initials: HJ
authors.lastname: Hwang
authors.affiliation: Gastroenterología, Hospital El Cruce, Argentina.
authors.forename: Martín Alejandro
authors.initials: MA
authors.lastname: Guidi
authors.affiliation: Gastroenterología, Hospital en red El Cruce, Argentina.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Curvale
authors.affiliation: Endoscopia, Hospital Posadas.
authors.forename: Juan
authors.initials: J
authors.lastname: Lasa
authors.affiliation: Gastroenterología, Hospital El Cruce.
authors.forename: Raúl
authors.initials: R
authors.lastname: Matano
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000191:economics / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000191:economics / Q000209:etiology* / Q000628:therapy*; D010865:Pilot Projects; D015607:Stents