Evaluation of pancreatic duct stenting for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult cannulating patients with calcular obstructive jaundice

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) was first described as a diagnostic technique. ERCP is used for management of various biliary and pancreatic diseases. Post-ERCP pancreatitis is defined as new-onset abdominal pain following ERCP, which is associated with amylase levels that are elevated three times the normal range, Pancreatic stenting is widely employed after pancreatic sphincterotomy with goals of reducing both early restenosis and post-ERCP pancreatitis. The risk of pancreatitis is significantly decreased when a pancreatic stent is placed and then left in following a precut sphincterotomy. Aim To evaluate the efficacy of pancreatic stent to decrease the risk of post-ERCP pancreatitis in patients with calcular obstructive jaundice. Patients and methods A prospective randomized study was conducted that included 40 patients with obstructive jaundice with a difficult biliary cannulation who are at risk to develop post-ERCP pancreatitis in patients with calcular obstructive jaundice. Group A included 20 patients with manipulation of pancreatic duct guidewire without pancreatic stent insertion. Group B included 20 patients with manipulation of pancreatic duct guidewire with pancreatic stent insertion. Results There was a highly statistically significant. Pancreatic stent placement decreases the risk of post-ERCP pancreatitis. Conclusion Prophylactic pancreatic duct stenting after difficult cannulation of the pancreatic duct is a safe and feasible procedure and significantly reduces the rate of post-ERCP pancreatitis.