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Prevention of post-ERCP pancreatitis using pancreatic duct stenting in difficult cannulation patients with calcular biliary bbstruction



Abstract

Background: Post-ERCP pancreatitis (PEP) has been the most frequent complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). It has been documented to happen after 5–30% of ERCP procedures. PEP is new or exacerbated abdominal pain associated with a serum lipase or amylase concentration which is more than three times the upper limit of normal at 24 hours post-ERCP, requiring at least two days of prolongation of the planned admission. Following pancreatic sphincterotomy, pancreatic stenting is commonly used with the objective of decreasing both early restenosis and post-ERCP pancreatitis. Aim of the work: Evaluation of the pancreatic stenting technique as a preventive measure against post ERCP pancreatitis in calcular obstructive jaundice patients with difficult cannulation.

Patients and methods: Forty Egyptian patients with calcular biliary obstruction with a difficult biliary cannulation who are at risk of developing PEP enrolled in a prospective randomized controlled comparative study. Group A: 20 patients with manipulation of pancreatic duct by guidewire without pancreatic stent insertion; Group B: 20 patients with manipulation of pancreatic duct by guidewire with pancreatic stent insertion.

Results: The pancreatic duct stenting technique had reduced the risk of PEP significantly in calcular biliary obstruction patients with difficult CBD cannulation to 20?% (in group B) compared with 60?% in (group A).

Conclusion: Prophylactic pancreatic stenting technique is a simple and easy procedure that showed to be efficient in decreasing cases of post ERCP pancreatitis in difficult cannulation patients. The endoscopists should be trained to practice the procedure safely.

 

Keywords: Endoscopic retrograde cholangiopancreatography (ERCP) pancreatic stenting and pancreatitis

References

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How to Cite

Abdel Rahim, A., Elrefaiy, M. A., Morsy, S. A., El Saadany, M. M., & Mashaal, A. R. (2021). Prevention of post-ERCP pancreatitis using pancreatic duct stenting in difficult cannulation patients with calcular biliary bbstruction. Bali Medical Journal, 10(3), 1061–1066. https://doi.org/10.15562/bmj.v10i3.2665
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Ali Abdel Rahim
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Mohamed A. Elrefaiy
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Shereif Ahmed Morsy
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Mariam Mosaad El Saadany
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Ahmed R. Mashaal
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