Moffatt Dana C, Pradermchai Kongkam, Avula Haritha, Sherman Stuart, Fogel Evan L, Lehman Glen A
Indiana University Medical Center, Indiana University, Indianapolis, IN, USA.
Can J Gastroenterol. 2011 Apr;25(4):215-9. doi: 10.1155/2011/678540.
Placement of prophylactic pancreatic stents (PPS) is a method proven to reduce the rate and severity of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; however, PPS do not eliminate the risk completely. Early PPS dislodgement may occur prematurely and contribute to more frequent or severe PEP.
To determine the effect of early dislodgement of PPS in patients with moderate or severe PEP.
A total of 27,176 ERCP procedures from January 1994 to September 2007 for PPS placement in high-risk patients were analyzed. Patient and procedure data were analyzed to assess risk factors for PEP, and to evaluate the severity of pancreatitis, length of hospitalization and subsequent complications. Timing of stent dislodgment was assessed radiographically.
PPS were placed in 7661 patients. Of these, 580 patients (7.5%) developed PEP, which was graded as mild in 460 (6.0%), moderate in 87 (1.1%) and severe in 33 (0.4%). Risk factors for developing PEP were not different in patients who developed moderate PEP compared with those with severe PEP. PPS dislodged before 72 h in seven of 59 (11.9%) patients with moderate PEP and five of 27 (18.5%) patients with severe PEP (P=0.505). The mean (± SD) length of hospitalization in patients with moderate PEP with stent dislodgement before and after 72 h were 7.43 ± 1.46 days and 8.37 ± 1.16 days, respectively (P=0.20). The mean length of hospitalization in patients with severe PEP whose stent dislodged before and after 72 h were 21.6 ± 6.11 and 22.23 ± 3.13 days, respectively (P=0.96).
Early PPS dislodgement was associated with moderate and severe PEP in less than 20% of cases and was not associated with a more severe course. Factors other than ductal obstruction contribute to PEP in high-risk patients undergoing ERCP and PPS placement.
放置预防性胰管支架（PPS）是一种已被证实可降低高危患者内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）发生率及严重程度的方法；然而，PPS并不能完全消除风险。早期PPS移位可能过早发生，并导致更频繁或更严重的PEP。
确定PPS早期移位对中度或重度PEP患者的影响。
分析了1994年1月至2007年9月期间共27176例为高危患者放置PPS的ERCP手术。分析患者和手术数据，以评估PEP的危险因素，并评估胰腺炎的严重程度、住院时间及随后的并发症。通过影像学评估支架移位的时间。
7661例患者放置了PPS。其中，580例（7.5%）发生PEP，其中460例（6.0%）为轻度，87例（1.1%）为中度，33例（0.4%）为重度。发生中度PEP的患者与发生重度PEP的患者相比，发生PEP的危险因素并无差异。59例中度PEP患者中有7例（11.9%）、27例重度PEP患者中有5例（18.5%）的PPS在72小时前移位（P = 0.505）。支架在72小时前后移位的中度PEP患者的平均（±标准差）住院时间分别为7.43±1.46天和8.37±1.16天（P = 0.20）。支架在72小时前后移位的重度PEP患者的平均住院时间分别为21.6±6.11天和22.23±3.13天（P = 0.96）。
早期PPS移位在不到20%的病例中与中度和重度PEP相关，且与病情更严重无关。在接受ERCP和PPS放置的高危患者中，除导管阻塞外的其他因素也会导致PEP。
