Rescue ERCP and insertion of a small-caliber pancreatic stent to prevent the evolution of severe post-ERCP pancreatitis: a case-controlled series.

Abstract

INTRODUCTION:

Recently prophylactic placement of a trans-sphincteric pancreatic stent has successfully been applied to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Rescue ERCP and emergency application of small-caliber pancreatic stents during the early course of post-ERCP pancreatitis as a possible endoscopic therapy has not been reported yet.

METHODS:

All patients who underwent ERCP were hospitalized for at least 24 h, with routine laboratory testing of amylase levels. Out of 1,225 ERCPs, evolution of severe post-ERCP pancreatitis was anticipated in six consecutive patients, based on severe pancreatic pain attack, more than tenfold elevation of serum amylase levels at 8 and 24 h, and moderate rise of white blood cell (WBC) and C-reactive protein (CRP) levels. Rescue ERCP and emergency application of small-caliber (4-5F, 4-cm, Geenen stent) pancreatic stents were successfully performed in all patients within 8-20 h after the initial ERCP.

RESULTS:

Moderate to severe papillary oedema was observed in all patients during the rescue ERCP. Pancreatic pain was promptly reduced after the rescue pancreatic drainage procedure and completely diminished within 24 h after pancreatic stenting. Serum amylase levels were exponentially reduced and normalized within 72 h in all patients; no pancreatic necrosis or any other late complications were observed. Pancreatic stents could be safely removed a few days later.

CONCLUSION:

Rescue pancreatic stenting with small-caliber prophylactic pancreatic stents seems to be a safe and effective procedure that might be feasible to stop the evolution of severe post-ERCP pancreatitis, but prospective controlled studies are clearly demanded to support this innovative approach.

• Authors: László Madácsy, Gábor Kurucsai, Ildikó Joó, Szilárd Gódi, Roland Fejes, András Székely
• Journal: Surgical endoscopy (Surg Endosc) Vol. 23 Issue 8 Pg. 1887-93 (Aug 2009) ISSN: 1432-2218 [Electronic] Germany
• PMID: 19057957 (Publication Type: Case Reports, Evaluation Study, Journal Article)

Chemical References

• C-Reactive Protein
• Amylases

Topics

• Acute Disease
• Adenoma, Villous (surgery)
• Aged
• Amylases (blood)
• C-Reactive Protein (analysis)
• Case-Control Studies
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, methods)
• Cholecystectomy
• Choledocholithiasis (complications, surgery)
• Cholestasis, Extrahepatic (etiology, surgery)
• Common Bile Duct Neoplasms (surgery)
• Device Removal
• Equipment Design
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Ducts (pathology)
• Pancreatitis (blood, etiology, prevention & control, surgery)
• Postoperative Complications (blood, etiology, prevention & control, surgery)
• Recurrence
• Reoperation
• Sphincterotomy, Endoscopic
• Stents