Views:2 Author:Site Editor Publish Time: 2019-06-11 Origin:Site
How Stents Work in Post ERCP Pancreatitis(PEP) Prevention
Pancreatitis is the most common complication of ERCP. The occurrence rate, according to a random retrospective contrast experiment in 108 patients, is 9.7%. For patients of PEP regular risks, the occurrence rate is 8.8%. For patients of PEPhigh risks, the occurrence rate is 14.7%.
High risk elements of pancreatitis include pancreatitis history, female, age younger than 40, dysfunction of oddi sphincter, etc. Some important steps in operation handling could also lead to high risks, such as difficult intubation, wire repeatedly entering pancreatic duct, pre-incision of pancreatic duct.
How to prevent PEP is hot topic clinically. Here we introduce one main approach, that is stent implantation.
In many analyzing researches, the results prove that implanting plastic stent as a preventive measurement could lower the occurrence rate of PEP to 60% to 80%.
Pancreatic plastic stent implantation is a commonly recognized and guideline recommended preventive measurement of PEP, especially in high risks cases, for instance, when guide wire enters pancreatic duct by mistake.
Plastic stent implantationis effective to lower the occurrence rate of severe pancreatitis, mild to moderate pancreatitis and hyperamylasemia as well.
Stent size choices are according to physicians’ personal experience. A recent Meta analysis shows that the diameter of stent is the main point to consider. Stent of diameter 5 Fr has better performance than 3 Fr. The stent with wings or without wings do not affect the result a lot.
The time of placement is 1-14 days. No agreement is reached in this point. While some random experiments show that 7~10 days placement of stent has lower rate of pancreatitis than stent removal immediately after ERCP operation.
It should be pointed out that failure of stent implantation shall injury the pancreatic duct and therefore leads to high rate of PEP. In the cases of difficult intubation into pancreatic duct or difficult stent implantation, the operator should consider the stent implantation prudently.
Other preventive measurements include Indometacin suppositories and large amount of rehydration. Researches show that use 100mg Indometacin suppositories immediately after ERCP operation could lower the occurrence rate of ERCP remarkably. Large amount supply of Lactated Ringer’s solution during the operation is found to be effective in decreasing PEP.