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Published in:

01-09-2013

Systematic pancreatic stenting after endoscopic snare papillectomy may reduce the risk of postinterventional pancreatitis

Authors: Bertrand Napoléon, M. Victoria Alvarez-Sanchez, Philippe Leclercq, François Mion, Jean Pialat, Rodica Gincul, Daniel Ribeiro, Marie Cambou, Christine Lefort, Mar Rodríguez-Girondo, Jean Yves Scoazec

Published in: Surgical Endoscopy | Issue 9/2013

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.

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Title: Systematic pancreatic stenting after endoscopic snare papillectomy may reduce the risk of postinterventional pancreatitis
Authors: Bertrand Napoléon
M. Victoria Alvarez-Sanchez
Philippe Leclercq
François Mion
Jean Pialat
Rodica Gincul
Daniel Ribeiro
Marie Cambou
Christine Lefort
Mar Rodríguez-Girondo
Jean Yves Scoazec
Publication date: 01-09-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2920-9

At a glance: The STEP trials

Springer Medicine

Systematic pancreatic stenting after endoscopic snare papillectomy may reduce the risk of postinterventional pancreatitis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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