A long (7 cm) prophylactic pancreatic stent decreases incidence of post-endoscopic papillectomy pancreatitis: a retrospective study

Kazuhiro Minami; Eisuke Iwasaki; Shintaro Kawasaki; Seiichiro Fukuhara; Takashi Seino; Tadashi Katayama; Yoichi Takimoto; Hiroki Tamagawa; Yujiro Machida; Masayasu Horibe; Minoru Kitago; Haruhiko Ogata; Takanori Kanai

doi:10.1055/a-1010-5581

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1663-E1670
DOI: 10.1055/a-1010-5581

Original article

A long (7 cm) prophylactic pancreatic stent decreases incidence of post-endoscopic papillectomy pancreatitis: a retrospective study

Kazuhiro Minami

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Eisuke Iwasaki

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Shintaro Kawasaki

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Seiichiro Fukuhara

²Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan

,

Takashi Seino

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Tadashi Katayama

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Yoichi Takimoto

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Hiroki Tamagawa

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Yujiro Machida

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Masayasu Horibe

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

,

Minoru Kitago

³Division of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan

,

Haruhiko Ogata

²Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan

,

Takanori Kanai

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

› Author Affiliations

Abstract

Background and study aims Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary neoplasms and is recognized as an alternative treatment to surgical resection; however, there are few reports on a suitable pancreatic stent (PS) after EP for preventing pancreatitis. The aim of this study was to evaluate the efficacy of a long PS after EP.

Patients and methods In this retrospective single-center study, 39 patients with pathologically proven ampullary neoplasms who underwent EP between March 2012 and August 2018 were enrolled. The study participants were divided into two subgroups according to the PS length: those with a PS shorter than 5 cm (short PS group, n = 17) and those with a PS of 7 cm (long PS group, n = 22). The incidence of adverse events and risk factors for pancreatitis were evaluated.

Results The diameter of all PSs was 5 Fr. Post-EP pancreatitis occurred in nine patients (23.1 %), with two cases of severe pancreatitis (5.1 %). Pancreatitis occurred more frequently in the short PS group (7/17, 41.2 %) than in the long PS group (2/22, 9.1 %) (P = 0.026). There were no significant differences between the two groups in terms of other adverse events. Univariate and multivariate analyses showed that a long PS was the only factor associated with a decreased incidence of post-EP pancreatitis (P = 0.042; odds ratio, 0.16; 95 % confidence interval, 0.027–0.94).

Conclusion A long (7 cm) PS significantly decreased incidence of pancreatitis after EP. Prospective randomized studies with a larger number of patients and wider range of PS lengths are required.

Full Text

References

References
1 Suzuki K, Kantou U, Murakami Y. Two cases with ampullary cancer who underwent endoscopic excision. Prog Dig Endosc 1983; 23: 236239
2 Catalano MF, Linder JD, Chak A. et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59: 225-232
3 Bohnacker S, Seitz U, Nguyen D. et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc 2005; 62: 551-560
4 Cheng CL, Sherman S, Fogel EL. et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc 2004; 60: 757-764
5 Stolte M, Pscherer C. Adenoma-carcinoma sequence in the papilla of Vater. Scand J Gastroenterol 1996; 31: 376-382
6 Yamaguchi K, Enjoji M. Carcinoma of the ampulla of Vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer 1987; 59: 506-515
7 Heinzow HS, Lenz P, Lenze F. et al. Feasibility of snare papillectomy in ampulla of Vater tumors: Meta-analysis and study results from a tertiary referral center. Hepatogastroenterol 2012; 59: 332-335
8 Ardengh JC, Kemp R, Lima-Filho ER. et al. Endoscopic papillectomy: The limits of the indication, technique and results. World J Gastrointest Endosc 2015; 7: 987-994
9 Napoleon B, Alvarez-Sanchez MV, Leclercq P. et al. Systematic pancreatic stenting after endoscopic snare papillectomy may reduce the risk of postinterventional pancreatitis. Surg Endosc 2013; 27: 3377-3387
10 Ito K, Fujita N, Noda Y. et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc 2012; 24: 30-35
11 Itoi T, Tsuji S, Sofuni A. et al. A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos). Gastrointest Endosc 2009; 69: 136-141
12 Lee TY, Cheon YK, Shim CS. et al. Endoscopic wire-guided papillectomy versus conventional papillectomy for ampullary tumors: A prospective comparative pilot study. J Gastroenterol Hepatol 2016; 31: 897-902
13 Hyun JJ, Lee TH, Park JS. et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc 2017; 85: 746-755
14 Choudhary A, Bechtold ML, Arif M. et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: A meta-analysis and systematic review. Gastrointest Endosc 2011; 73: 275-282
15 Sofuni A, Maguchi H, Itoi T. et al. Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent. Clin Gastroenterol Hepatol 2007; 5: 1339-1346
16 Napoleon B, Gincul R, Ponchon T. et al. Endoscopic papillectomy for early ampullary tumors: Long-term results from a large multicenter prospective study. Endoscopy 2014; 46: 127-134
17 Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc 2005; 62: 367-370
18 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 meta-analysis. Endoscopy 2014; 46: 573-580
19 Olsson G, Lubbe J, Arnelo U. et al. The impact of prophylactic pancreatic stenting on post-ERCP pancreatitis: A nationwide, register-based study. United European Gastroenterol J 2017; 5: 111-118
20 Ito K, Fujita N, Kanno A. et al. Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: A multicenter retrospective study. Intern Med 2011; 50: 2927-2932
21 Chandrasekhara V, Khashab MA. et al. ASGE Standards of Practice Committee. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
22 Tsuji S, Itoi T, Sofuni A. et al. Tips and tricks in endoscopic papillectomy of ampullary tumors: Single-center experience with large case series (with videos). J Hepatobiliary Pancreat Sci 2015; 22: E22-E27
23 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
24 Zhang C, Yang YL, Ma YF. et al. The modified pancreatic stent system for prevention of post-ERCP pancreatitis: A case-control study. BMC Gastroenterol 2017; 17: 108
25 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
26 Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: A systematic review and meta-analysis. Endoscopy 2010; 42: 842-853
27 Topazian M, Baron TH, Fidler JL. et al. Endoscopic retrieval of a migrated pancreatic stent from the retroperitoneum. Gastrointest Endosc 2008; 67: 728-729
28 Zapatier JA, Jani P, Pimentel R. et al. Pancreatic stent migration into the bile duct causing cholangitis. Endoscopy 2013; 45 (Suppl. 02) E324-E325
29 Leung WD, Parashette KR, Molleston JP. et al. Pancreatic stent migration into the portal vein causing portal vein thrombosis: A rare complication of a prophylactic pancreatic stent. Pancreatology 2012; 12: 463-465
30 Pelz J, Farnbacher MJ, Raithel M. et al. Perforation of the splenic artery as a complication of endoscopic pancreatic stent placement in chronic obstructing pancreatitis. Endoscopy 2013; 45 (Suppl. 02) E203-E204
31 Kubota K, Fujita Y, Sato T. et al. Tumor diameter and Ki-67 expression in biopsy could be diagnostic markers discriminating from adenoma and early stage cancer in patients with ampullary tumors. J Hepatobiliary Pancreat Sci 2013; 20: 531-537