Prophylactic pancreatic stents to prevent ERCP-induced pancreatitis: When do you use them?
- Stuart Sherman, MD
Stuart Sherman, MD
- Professor of Medicine and Radiology
- Indiana University School of Medicine
Endoscopic placement of polyethylene stents is a well-established therapy for treating a variety of benign and malignant biliary tract diseases. Although still in their infancy, application of similar techniques in the pancreas is emerging. Pancreatic duct stents have been placed to bridge dominant strictures, bypass obstructing pancreatic duct stones, drain pseudocysts, seal duct disruptions, treat symptomatic minor (ie, pancreas divisum) and/or major (ie, sphincter of Oddi dysfunction) sphincter stenosis, prevent procedure-induced pancreatitis, and serve as a guide for sphincterotomy (table 1).
This topic review will focus on the indications and efficacy of placing a pancreatic stent to prevent post-ERCP pancreatitis. An overview of pancreatic stenting and its complications is provided separately. (See "Overview of pancreatic stenting and its complications".)
RISK FACTORS FOR POST-ERCP PANCREATITIS
Pancreatitis is the most common complication of diagnostic and therapeutic ERCP occurring in 1 to 15 percent of patients. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications".)
The pancreas is subjected to many types of potential injury during ERCP and endoscopic sphincterotomy: mechanical, chemical, hydrostatic, enzymatic, microbiological, allergic, and thermal . These mechanisms of injury may act independently or in concert to induce post-procedure pancreatitis. Several patient and procedure-related risk factors for post-ERCP pancreatitis have been found, which are described separately. (See "Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis".)
Recognition of risk factors associated with post-ERCP pancreatitis provided the rationale for evaluating a number of measures for preventing post-ERCP pancreatitis. A possible approach is to use prophylactic pancreatic stents.
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- RISK FACTORS FOR POST-ERCP PANCREATITIS
- PROPHYLACTIC STENTING
- After excessive manipulations of the papilla
- Sphincter of Oddi dysfunction or a small bile duct
- Precut sphincterotomy
- Pancreatic sphincterotomy
- Balloon sphincter dilation
- Snare excision of the duodenal ampulla
- Routine prophylactic pancreatic duct stenting
- Facilitating bile duct cannulation
- COMPLICATIONS OF PANCREATIC STENTS
- SUMMARY AND RECOMMENDATIONS