Year 2018 / Volume 110 / Number 7
Original
Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP

416-420

DOI: 10.17235/reed.2018.5230/2017

Jesús García-Cano, Miriam Viñuelas Chicano, María del Moral Martínez, Marta Muñiz Muñoz, Claudio Murillo Matamoros, Miguel Suárez Matías, Laura Valiente González, Teresa Martínez Pérez, Raquel Martínez Fernández, Carmen Julia Gómez Ruiz, José Ignacio Pérez García, Julia Morillas Ariño,

Abstract
Introduction: the guidewire (GW) may enter the pancreatic duct during common bile duct (CBD) cannulation attempts in endoscopic retrograde cholangiopancreatography (ERCP). After GW passage into the pancreas, the most effective maneuver for CBD cannulation and pancreatitis prevention has not been determined. Aim: to study CBD cannulation and post-ERCP pancreatitis rates when a pancreatic stent is inserted after an unintentional GW cannulation of the pancreatic duct. Material and methods: a retrospective analysis of patients undergoing ERCP for biliary drainage that were included prospectively into a database. After unintentional GW cannulation of the pancreatic duct, a straight 5-Fr and 4-cm long plastic stent was inserted. The stents had no internal flaps to facilitate expulsion. CBD cannulation attempts were made above the stent. A pancreatic sphincterotomy was performed in patients older than 60 years before stent insertion. Results: a total of 46 pancreatic stents were inserted during 154 ERCP (29.8%) procedures. In the stent group, CBD cannulation was accomplished in 44/46 (95.6%) subjects. A total of 21/46 (45.6%) pancreatic sphincterotomies were performed. Only 1/46 (2.17%) mild pancreatitis cases were observed and most stents were spontaneously expelled. Conclusions: in this study, the CBD was eventually reached with the insertion of a plastic pancreatic stent after an unintentional GW passage into the pancreatic duct while attempting a CBD cannulation. No adverse events were observed following pancreatic stent insertion.
Share Button
New comment
Comments
No comments for this article
References
1. García-Cano J. What is the most cost-effective method for a difficult biliary cannulation in ERCP? Rev Esp Enferm Dig 2017;109:171-173. doi: 10.17235/reed.2017.4863/2017.
2. Nakai Y, Isayama H, Sasahira N, et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc 2015;81:119-26. doi: 10.1016/j.gie.2014.06.005.
3. García-Cano J, Godoy-López MA, Taberna-Arana L. Common bile duct acces in ERCP over a new plastic pancreatic stent after unintentional pancreatic guidewire cannulation. Gastrointest Endosc 2016; 83 (5S): AB 455-456.
4. Afghani E, Akshintala VS, Khashab MA et al. 5-Fr vs. 3-Fr pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients: A systematic review and network metaanalysis. Endoscopy 2014; 46: 573–80.
5. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-93.
6. García-Cano J, González Martín JA, Morillas Ariño J, et al. Complications of endoscopic retrograde cholangiopancreatography. A study in a small ERCP unit. Rev Esp Enferm Dig 2004;96:163-73.
7. Laquiere A, Desilets E, Belle A, et al. Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies. Dig Endosc 2017;29:182-189. doi: 10.1111/den.12740.
8. Dumonceau JM, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
updated June 2014. Endoscopy 2014;46:799-815. DOI: 10.1055/s-0034-1377875
9. Ito K, Fujita N, Noda Y, et al. Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial. J Gastroenterol. 2010;45:1183-91. doi: 10.1007/s00535-010-0268-7.
10. Coté GA, Ansstas M, Pawa R, et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video). Gastrointest Endosc. 2010 Feb;71(2):275-9. doi: 10.1016/j.gie.2009.08.028.
11. Buxbaum J, Leonor P, Tung J, et al. Randomized trial of endoscopist-controlled vs. assistant-controlled wire-guided cannulation of the bile duct. Am J Gastroenterol 2016;111:1841-1847. doi: 10.1038/ajg.2016.268.
12. Hwang HJ, Guidi M, Curvale C, et al. Post-ERCP pancreatitis: Early precut or pancreatic duct stent? A multicenter, randomized-controlled trial and costeffectiveness
analysis. Rev Esp Enferm Dig 2017;109:174-9. DOI: 10.17235/reed.2017.4565/2016.
13. Moffatt DC, Coté GA, Fogel EL, et al. Acute pancreatitis after removal of retained prophylactic pancreatic stents. Gastrointest Endosc 2011;73:980-6. doi: 10.1016/j.gie.2011.01.012.
14. García-Cano J, Reyes Guevara AK, Martínez Pérez T, et al. Prevención de la pancreatitis aguda post-CPRE con la administración de diclofenaco inravenoso tras la intervención endoscópica. Rev Esp Enferm Dig 2013; 105 (Supl.I): 106.
15. Hamada T, Nakai Y, Isayama H, Koike K. Toward routine use of non-steroidal anti-inflammatory drugs for patients undergoing endoscopic retrograde cholangiopancreatography. Dig Endosc 2017;29:291-293. doi: 10.1111/den.12831.
16. Patai Á, Solymosi N, Mohácsi L, Patai ÁV. Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointest Endosc 2017;85:1144-1156.e1. doi: 10.1016/j.gie.2017.01.033.
17. Fujita Y, Hasegawa S, Kato Y, et al Intravenous injection of low-dose flurbiprofen axetil for preventing post-ERCP pancreatitis in high-risk patients: An interim analysis of the trial. Endosc Int Open 2016;4:E1078-E1082.
Related articles

Letter

Disconnected pancreatic duct syndrome. Endoscopic approach

DOI: 10.17235/reed.2022.9261/2022

Editorial

Pancreatic stents in ERCP. Where are we?

DOI: 10.17235/reed.2018.5670/2018

Editorial

Pursuing excellence in ERCP

DOI: 10.17235/reed.2018.5373/2017

Citation tools
García-Cano J, Viñuelas Chicano M, del Moral Martínez M, Muñiz Muñoz M, Murillo Matamoros C, Suárez Matías M, et all. Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP. 5230/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1464 visits.
This article has been downloaded 332 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 19/08/2017

Accepted: 24/01/2018

Online First: 12/04/2018

Published: 02/07/2018

Article revision time: 134 days

Article Online First time: 236 days

Article editing time: 317 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology