Olsson Greger, Lübbe Jeanne, Arnelo Urban, Jonas Eduard, Törnqvist Björn, Lundell Lars, Enochsson Lars
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Highland Hospital, Eksjö, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
United European Gastroenterol J. 2017 Feb;5(1):111-118. doi: 10.1177/2050640616645434. Epub 2016 Jul 8.
The role of prophylactic pancreatic stenting (PS) in preventing post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP) has yet to be determined. Most previous studies show beneficial effects in reducing PEP when prophylactic pancreatic stents are used, especially in high-risk ERCP procedures. The present study aimed to address the use of PS in a nationwide register-based study in which the primary outcome was the prophylactic effect of PS in reducing PEP.
All ERCP-procedures registered in the nationwide Swedish Registry for Gallstone Surgery and ERCP (GallRiks) between 2006 and 2014 were studied. The primary outcome was PEP but we also studied other peri- and postoperative complication rates.
Data from 43,595 ERCP procedures were analyzed. In the subgroup of patients who received PS with a total diameter ≤ 5 Fr, the risk of PEP increased nearly four times compared to those who received PS with a total diameter of >5 Fr (OR 3.58; 95% CI 1.40-11.07). Furthermore, patients who received PS of >5 Fr and >5 cm had a significantly lower pancreatitis frequency compared to those with shorter stents of the same diameter (1.39% vs 15.79%; = 0.0033).
PS with a diameter of >5 Fr and a length of >5 cm seems to have a better protective effect against PEP, compared to shorter and thinner stents. However, in the present version of GallRiks it is not possible to differentiate the exact type of pancreatic stent (apart from material, length and diameter) that has been introduced, so our conclusion must be interpreted with caution.
预防性胰管支架置入术（PS）在预防内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）中的作用尚未确定。此前大多数研究表明，使用预防性胰管支架可降低PEP的发生率，尤其是在高风险ERCP手术中。本研究旨在通过一项基于全国登记系统的研究探讨PS的应用，该研究的主要结局是PS在降低PEP方面的预防效果。
对2006年至2014年瑞典全国胆结石手术和ERCP登记系统（GallRiks）中登记的所有ERCP手术进行研究。主要结局是PEP，但我们也研究了其他围手术期和术后并发症发生率。
分析了43,595例ERCP手术的数据。在接受总直径≤5Fr胰管支架的患者亚组中，与接受总直径>5Fr胰管支架的患者相比，PEP风险增加近四倍（OR 3.58；95%CI 1.40 - 11.07）。此外，与相同直径的较短支架相比，接受>5Fr且>5cm胰管支架的患者胰腺炎发生率显著更低（1.39%对15.79%；P = 0.0033）。
与更短、更细的支架相比，直径>5Fr且长度>5cm的胰管支架似乎对PEP具有更好的保护作用。然而，在当前版本的GallRiks中，无法区分所置入的胰管支架的确切类型（除了材料、长度和直径），因此我们的结论必须谨慎解读。
