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Medline ® Abstract for Reference 42

of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis'

Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents.
CotéGA, Kumar N, Ansstas M, Edmundowicz SA, Jonnalagadda S, Mullady DK, Azar RR
Gastrointest Endosc. 2010;72(4):748.
BACKGROUND: There are conflicting data on the risk of post-ERCP pancreatitis (PEP) related to self-expandable metallic stents (SEMSs).
OBJECTIVE: To compare rates of PEP in patients who undergo biliary drainage with SEMSs or polyethylene stents (PSs).
DESIGN: Retrospective, cohort study.
SETTING: Tertiary-care medical center.
PATIENTS: This study involved patients undergoing ERCP for malignant biliary obstruction between January 2005 and October 2008.
INTERVENTION: First-time placement of a SEMS or PS for biliary decompression.
MAIN OUTCOME MEASUREMENTS: Early post-ERCP complications, particularly PEP.
RESULTS: We identified 544 eligible patients, 248 SEMSs (102 covered), and 296 PSs. The etiology of malignant biliary obstruction was similar between groups, with 55% from pancreatic cancer. The frequency of PEP was significantly higher in the SEMS group (7.3%) versus the PS group (1.3%) (OR 5.7 [95% CI, 1.9-17.1]). On univariate analysis, patient age of<40 years, a history of PEP, and at least 1 pancreatic duct injection were also significant predictors of PEP, whereas female sex and having pancreatic cancer were not. When significant variables were added to a multiple-predictor regression model, the odds of PEP from SEMS placement increased to 6.8 (95% CI, 2.2, 21.4). However, the frequency of PEP was similar between covered (6.9%) and uncovered (7.5%) SEMSs (OR 0.9 [CI, 0.3-2.4]). Purported SEMS-specific risk factors, including the use of cSEMSs, overlapping SEMSs, or having a biliary sphincterotomy were not found to be significant contributors to the higher risk.
LIMITATIONS: Retrospective design.
CONCLUSION: After we controlled for confounding variables, the frequency of PEP was significantly higher with placement of a SEMS compared with a PS. Rates of PEP were comparable with use of covered and uncovered SEMSs.
Division of Gastroenterology, Washington University, St Louis School of Medicine, St Louis, Missouri, USA. gcote@iupui.edu