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Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.
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Pancreatic Duct Stent placement prevents post ercp pancreatitis in patients with suspected sphincter of oddi dysfunction but normal manometry results
Gastrointestinal Endoscopy, 2008Co-Authors: Abdo Saad, Stuart Sherman, Evan L Fogel, Lee Mchenry, James L Watkins, Laura Lazzellpannell, Glen A LehmanAbstract:Background Placement of a Pancreatic Duct (PD) Stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective Our purpose was to determine whether PD Stent placement reduces pancreatitis rates in this patient population. Design Non-randomized, retrospective study. Setting Large, tertiary referral center. Patients From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions PD Stent placement. Main Outcome Measurement Pancreatitis rates. Results A total of 403 patients were available for analysis: 169 had a PD Stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 ( P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 ( P P = .012). In patients with prior sphincter therapy, no benefit was seen from Stent placement, although there was a trend to decreased pancreatitis rates in Stented patients with prior pancreatobiliary sphincterotomy. Limitations Nonrandomized, retrospective design. Conclusion Temporary PD Stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.
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sphincter of oddi dysfunction Pancreaticobiliary sphincterotomy with Pancreatic Stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone
Endoscopy, 2002Co-Authors: Evan L Fogel, D Eversman, P Jamidar, S Sherman, Glen A LehmanAbstract:Background and Study Aims: Patients with suspected or documented sphincter of Oddi dysfunction (SOD) who undergo standard biliary sphincterotomy have high rates of post-procedure pancreatitis. Approximately 75% of such patients have elevated basal pressures of the Pancreatic sphincter. Biliary sphincterotomy (BES) on its own leaves the Pancreatic sphincter unablated and may cause transient edema which aggravates the increase in Pancreatic sphincter pressure. Combined Pancreaticobiliary therapy (PBR), using Pancreatic Stenting in addition to sphincterotomy may therefore be safer. Patients and Methods: The endoscopic retrograde cholangiopancreatography (ERCP) database was queried for patients with successful double-Duct sphincter of Oddi manometry (SOM) who underwent BES alone or PBR between 1994 and 1997. The endoscopist had decided on the technique to be used. From 1995 to 1997 there was a general trend to do PBR. Pancreatitis was defined according to established criteria. Results: The post-ERCP pancreatitis rate among all 436 SOD patients was 19.7%, while 256 patients with normal SOM results had a pancreatitis rate of 12.9%. The use of combined PBR was associated with a lower frequency of pancreatitis compared with BES alone (needle-knife over Pancreatic Duct Stent, 14/131 patients, 10.7%; pull-type Pancreaticobiliary sphincterotomy plus Pancreatic Stent, 15/78 patients, 19.2%; BES alone, 52/184 patients, 28.3%). Episodes of moderate and severe pancreatitis were seen more frequently in the BES group. Conclusion: In SOD patients, post-ERCP pancreatitis rates remain high, but have improved with the addition of combined Pancreaticobiliary sphincter therapy.
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4611 does placement of a small diameter long length unflanged Pancreatic Duct Stent reduce the incidence of post ercp pancreatitis
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Lois Bucksot, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct (PD) Stent placement reduces pancreatitis rates following needle-knife pre-cut biliary sphincterotomy (ES) or pancreatobiliary ES in pts with sphincter of Oddi dysfunction (SOD). Such Stents have typically been 4-5F diameter and 2cm long.We hypothesized that a small diameter Stent would cause less Ductal irritation, but longer lengths might prevent premature dislodgment. Small diameter (3F), long length (8-10cm) unflanged PD Stents have a high spontaneous dislodgment rate (83%), and they appear to be infrequently associated with PD injury. It has been suggested that the 3F luminal diameter may obstruct prematurely, resulting in increased pancreatitis rates. This study addresses this concern. Methods: From 1/94-10/99, 1087 pts had a 3/4-single pigtail unflanged PD Stent (Wilson-Cook, Winston- Salem, NC) placed at ERCP for a variety of conditions. Stent diameter ranged from 3-7F. All 3F Stents were 8-10cm long, while the other Stents were 2-10cm, with a variable length remaining in the duodenal lumen. Results: See Table. Summary: 1.Pancreatitis rates remain relatively high (13.8%) in these high-risk patients. 2. Placement of a small diameter (3F), unflanged PD Stent is no less effective than larger diameter Stents in prevention of pancreatitis. Moderate to severe pancreatitis rates are lower than historical controls. Conclusion: Prospective randomized trials comparing 3F and larger diameter Stents (of varying lengths) would be of interest. Further study addressing PD and parenchymal injury with these Stents is ongoing.
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4621 Alterations in Pancreatic Ductal morphology following small diameter, long length, unflanged Pancreatic Duct Stent placement.
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Susan D. Phillips, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct Stents are being increasingly used in a variety of conditions. However, Stent-induced Ductal and parenchymal injury is common, and may be irreversible. Small diameter (3-4F), long length (8-10cm), unflanged Stents frequently dislodge spontaneously, potentially limiting Ductal injury. This study examined the frequency of morphologic changes noted with these Stents. Methods: From 9/1/97- 10/20/99, 86 pts who had undergone Pancreatic Stenting with a 3/4-single pigtail, 3-4F diameter, 8-10cm long Stent modified with no intraDuctal flange (Wilson-Cook, Winston-Salem, NC) had follow-up pancreatograms available for review. Repeat exams were performed for Stent removal (failure to spontaneously dislodge within 30 days) or symptomatic recurrence (long after Stent migration or removal, mean 11 months, range 2-22). Stent-induced changes were graded as mild ( 50%). Results: see Table. Summary: When using 3-4F Stents, Stent-induced Ductal changes were frequently seen at 30 days, but rarely found on long-term follow-up. 2. There was no significant difference between 3F and 4F Stents. Conclusion: This preliminary study suggests that concern over Ductal changes with use of small diameter, long length unflanged Stents remains, but their use may result in a lower incidence of irreversible Stent-induced changes (i.e. fibrosis). Further study is indicated to identify the ideal Stent characteristics required to reduce post-ERCP pancreatitis rates yet avoid Ductal and parenchymal injury.
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increased selective biliary cannulation rates in the setting of periampullary diverticula main Pancreatic Duct Stent placement followed by pre cut biliary sphincterotomy
Gastrointestinal Endoscopy, 1998Co-Authors: Evan L Fogel, Stuart Sherman, Glen A LehmanAbstract:Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a Pancreatic Duct Stent. Needle-knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main Pancreatic Duct Stent keeps the papilla out of the diverticulum, thereby facilitating pre-cut needle-knife sphincterotomy and selective biliary cannulation.
Stuart Sherman - One of the best experts on this subject based on the ideXlab platform.
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which Pancreatic Duct Stent is best in patients at risk for post ercp pancreatitis
NEJM Journal Watch, 2009Co-Authors: Stuart ShermanAbstract:Prophylactic Pancreatic Duct (PD) Stenting lowers the incidence of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in
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Pancreatic Duct Stent placement prevents post ercp pancreatitis in patients with suspected sphincter of oddi dysfunction but normal manometry results
Gastrointestinal Endoscopy, 2008Co-Authors: Abdo Saad, Stuart Sherman, Evan L Fogel, Lee Mchenry, James L Watkins, Laura Lazzellpannell, Glen A LehmanAbstract:Background Placement of a Pancreatic Duct (PD) Stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective Our purpose was to determine whether PD Stent placement reduces pancreatitis rates in this patient population. Design Non-randomized, retrospective study. Setting Large, tertiary referral center. Patients From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions PD Stent placement. Main Outcome Measurement Pancreatitis rates. Results A total of 403 patients were available for analysis: 169 had a PD Stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 ( P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 ( P P = .012). In patients with prior sphincter therapy, no benefit was seen from Stent placement, although there was a trend to decreased pancreatitis rates in Stented patients with prior pancreatobiliary sphincterotomy. Limitations Nonrandomized, retrospective design. Conclusion Temporary PD Stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.
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Prophylactic Pancreatic Stents Prevent Post-ERCP Pancreatitis: A Meta-Analysis
NEJM Journal Watch, 2004Co-Authors: Stuart ShermanAbstract:Data conflict on the value of prophylactic Pancreatic-Duct Stent placement for preventing post-endoscopic retrograde cholangiopancreatography (ERCP)
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4611 does placement of a small diameter long length unflanged Pancreatic Duct Stent reduce the incidence of post ercp pancreatitis
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Lois Bucksot, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct (PD) Stent placement reduces pancreatitis rates following needle-knife pre-cut biliary sphincterotomy (ES) or pancreatobiliary ES in pts with sphincter of Oddi dysfunction (SOD). Such Stents have typically been 4-5F diameter and 2cm long.We hypothesized that a small diameter Stent would cause less Ductal irritation, but longer lengths might prevent premature dislodgment. Small diameter (3F), long length (8-10cm) unflanged PD Stents have a high spontaneous dislodgment rate (83%), and they appear to be infrequently associated with PD injury. It has been suggested that the 3F luminal diameter may obstruct prematurely, resulting in increased pancreatitis rates. This study addresses this concern. Methods: From 1/94-10/99, 1087 pts had a 3/4-single pigtail unflanged PD Stent (Wilson-Cook, Winston- Salem, NC) placed at ERCP for a variety of conditions. Stent diameter ranged from 3-7F. All 3F Stents were 8-10cm long, while the other Stents were 2-10cm, with a variable length remaining in the duodenal lumen. Results: See Table. Summary: 1.Pancreatitis rates remain relatively high (13.8%) in these high-risk patients. 2. Placement of a small diameter (3F), unflanged PD Stent is no less effective than larger diameter Stents in prevention of pancreatitis. Moderate to severe pancreatitis rates are lower than historical controls. Conclusion: Prospective randomized trials comparing 3F and larger diameter Stents (of varying lengths) would be of interest. Further study addressing PD and parenchymal injury with these Stents is ongoing.
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4621 Alterations in Pancreatic Ductal morphology following small diameter, long length, unflanged Pancreatic Duct Stent placement.
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Susan D. Phillips, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct Stents are being increasingly used in a variety of conditions. However, Stent-induced Ductal and parenchymal injury is common, and may be irreversible. Small diameter (3-4F), long length (8-10cm), unflanged Stents frequently dislodge spontaneously, potentially limiting Ductal injury. This study examined the frequency of morphologic changes noted with these Stents. Methods: From 9/1/97- 10/20/99, 86 pts who had undergone Pancreatic Stenting with a 3/4-single pigtail, 3-4F diameter, 8-10cm long Stent modified with no intraDuctal flange (Wilson-Cook, Winston-Salem, NC) had follow-up pancreatograms available for review. Repeat exams were performed for Stent removal (failure to spontaneously dislodge within 30 days) or symptomatic recurrence (long after Stent migration or removal, mean 11 months, range 2-22). Stent-induced changes were graded as mild ( 50%). Results: see Table. Summary: When using 3-4F Stents, Stent-induced Ductal changes were frequently seen at 30 days, but rarely found on long-term follow-up. 2. There was no significant difference between 3F and 4F Stents. Conclusion: This preliminary study suggests that concern over Ductal changes with use of small diameter, long length unflanged Stents remains, but their use may result in a lower incidence of irreversible Stent-induced changes (i.e. fibrosis). Further study is indicated to identify the ideal Stent characteristics required to reduce post-ERCP pancreatitis rates yet avoid Ductal and parenchymal injury.
Evan L Fogel - One of the best experts on this subject based on the ideXlab platform.
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Pancreatic Duct Stent placement prevents post ercp pancreatitis in patients with suspected sphincter of oddi dysfunction but normal manometry results
Gastrointestinal Endoscopy, 2008Co-Authors: Abdo Saad, Stuart Sherman, Evan L Fogel, Lee Mchenry, James L Watkins, Laura Lazzellpannell, Glen A LehmanAbstract:Background Placement of a Pancreatic Duct (PD) Stent reduces post-ERCP pancreatitis rates in high-risk patients. Patients with suspected sphincter of Oddi dysfunction (SOD) who are found to have normal manometry results (SOM) are also at high risk for this complication. Objective Our purpose was to determine whether PD Stent placement reduces pancreatitis rates in this patient population. Design Non-randomized, retrospective study. Setting Large, tertiary referral center. Patients From January 1999 to December 2005, patients who underwent ERCP with normal SOM were identified from our ERCP database. Incidence of patient/procedure risk factors for post-ERCP pancreatitis, trainee participation, and prior sphincter therapy were evaluated. Interventions PD Stent placement. Main Outcome Measurement Pancreatitis rates. Results A total of 403 patients were available for analysis: 169 had a PD Stent placed (group 1) and 234 did not (group 2). Overall, pancreatitis rates were 2.4% in group 1 and 9.0% in group 2 ( P = .006, odds ratio 4.1, 95% CI 1.4-12.0). Other than increased PD opacification in group 1 ( P P = .012). In patients with prior sphincter therapy, no benefit was seen from Stent placement, although there was a trend to decreased pancreatitis rates in Stented patients with prior pancreatobiliary sphincterotomy. Limitations Nonrandomized, retrospective design. Conclusion Temporary PD Stent placement reduces pancreatitis rates in patients with suspected SOD but normal SOM and an intact papilla. Their routine use is recommended when evaluating this difficult, high-risk patient population.
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sphincter of oddi dysfunction Pancreaticobiliary sphincterotomy with Pancreatic Stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone
Endoscopy, 2002Co-Authors: Evan L Fogel, D Eversman, P Jamidar, S Sherman, Glen A LehmanAbstract:Background and Study Aims: Patients with suspected or documented sphincter of Oddi dysfunction (SOD) who undergo standard biliary sphincterotomy have high rates of post-procedure pancreatitis. Approximately 75% of such patients have elevated basal pressures of the Pancreatic sphincter. Biliary sphincterotomy (BES) on its own leaves the Pancreatic sphincter unablated and may cause transient edema which aggravates the increase in Pancreatic sphincter pressure. Combined Pancreaticobiliary therapy (PBR), using Pancreatic Stenting in addition to sphincterotomy may therefore be safer. Patients and Methods: The endoscopic retrograde cholangiopancreatography (ERCP) database was queried for patients with successful double-Duct sphincter of Oddi manometry (SOM) who underwent BES alone or PBR between 1994 and 1997. The endoscopist had decided on the technique to be used. From 1995 to 1997 there was a general trend to do PBR. Pancreatitis was defined according to established criteria. Results: The post-ERCP pancreatitis rate among all 436 SOD patients was 19.7%, while 256 patients with normal SOM results had a pancreatitis rate of 12.9%. The use of combined PBR was associated with a lower frequency of pancreatitis compared with BES alone (needle-knife over Pancreatic Duct Stent, 14/131 patients, 10.7%; pull-type Pancreaticobiliary sphincterotomy plus Pancreatic Stent, 15/78 patients, 19.2%; BES alone, 52/184 patients, 28.3%). Episodes of moderate and severe pancreatitis were seen more frequently in the BES group. Conclusion: In SOD patients, post-ERCP pancreatitis rates remain high, but have improved with the addition of combined Pancreaticobiliary sphincter therapy.
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4611 does placement of a small diameter long length unflanged Pancreatic Duct Stent reduce the incidence of post ercp pancreatitis
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Lois Bucksot, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct (PD) Stent placement reduces pancreatitis rates following needle-knife pre-cut biliary sphincterotomy (ES) or pancreatobiliary ES in pts with sphincter of Oddi dysfunction (SOD). Such Stents have typically been 4-5F diameter and 2cm long.We hypothesized that a small diameter Stent would cause less Ductal irritation, but longer lengths might prevent premature dislodgment. Small diameter (3F), long length (8-10cm) unflanged PD Stents have a high spontaneous dislodgment rate (83%), and they appear to be infrequently associated with PD injury. It has been suggested that the 3F luminal diameter may obstruct prematurely, resulting in increased pancreatitis rates. This study addresses this concern. Methods: From 1/94-10/99, 1087 pts had a 3/4-single pigtail unflanged PD Stent (Wilson-Cook, Winston- Salem, NC) placed at ERCP for a variety of conditions. Stent diameter ranged from 3-7F. All 3F Stents were 8-10cm long, while the other Stents were 2-10cm, with a variable length remaining in the duodenal lumen. Results: See Table. Summary: 1.Pancreatitis rates remain relatively high (13.8%) in these high-risk patients. 2. Placement of a small diameter (3F), unflanged PD Stent is no less effective than larger diameter Stents in prevention of pancreatitis. Moderate to severe pancreatitis rates are lower than historical controls. Conclusion: Prospective randomized trials comparing 3F and larger diameter Stents (of varying lengths) would be of interest. Further study addressing PD and parenchymal injury with these Stents is ongoing.
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4621 Alterations in Pancreatic Ductal morphology following small diameter, long length, unflanged Pancreatic Duct Stent placement.
Gastrointestinal Endoscopy, 2000Co-Authors: Evan L Fogel, Stuart Sherman, Benedict M. Devereaux, Rungsun Rerknimitr, Susan D. Phillips, Glen A LehmanAbstract:Background: Temporary Pancreatic Duct Stents are being increasingly used in a variety of conditions. However, Stent-induced Ductal and parenchymal injury is common, and may be irreversible. Small diameter (3-4F), long length (8-10cm), unflanged Stents frequently dislodge spontaneously, potentially limiting Ductal injury. This study examined the frequency of morphologic changes noted with these Stents. Methods: From 9/1/97- 10/20/99, 86 pts who had undergone Pancreatic Stenting with a 3/4-single pigtail, 3-4F diameter, 8-10cm long Stent modified with no intraDuctal flange (Wilson-Cook, Winston-Salem, NC) had follow-up pancreatograms available for review. Repeat exams were performed for Stent removal (failure to spontaneously dislodge within 30 days) or symptomatic recurrence (long after Stent migration or removal, mean 11 months, range 2-22). Stent-induced changes were graded as mild ( 50%). Results: see Table. Summary: When using 3-4F Stents, Stent-induced Ductal changes were frequently seen at 30 days, but rarely found on long-term follow-up. 2. There was no significant difference between 3F and 4F Stents. Conclusion: This preliminary study suggests that concern over Ductal changes with use of small diameter, long length unflanged Stents remains, but their use may result in a lower incidence of irreversible Stent-induced changes (i.e. fibrosis). Further study is indicated to identify the ideal Stent characteristics required to reduce post-ERCP pancreatitis rates yet avoid Ductal and parenchymal injury.
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increased selective biliary cannulation rates in the setting of periampullary diverticula main Pancreatic Duct Stent placement followed by pre cut biliary sphincterotomy
Gastrointestinal Endoscopy, 1998Co-Authors: Evan L Fogel, Stuart Sherman, Glen A LehmanAbstract:Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a Pancreatic Duct Stent. Needle-knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main Pancreatic Duct Stent keeps the papilla out of the diverticulum, thereby facilitating pre-cut needle-knife sphincterotomy and selective biliary cannulation.
Takashi Obana - One of the best experts on this subject based on the ideXlab platform.
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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
Journal of Gastroenterology, 2010Co-Authors: Naotaka Fujita, Yutaka Noda, Go Kobayashi, Jun Horaguchi, Osamu Takasawa, Takashi Obana, Shinsuke Koshita, Yoshihide Kanno, Takahisa OgawaAbstract:Background Although Pancreatic Duct guidewire placement (P-GW) for achieving selective biliary cannulation is reported to be effective in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) is difficult, this technique entails a possible increased risk of post-ERCP pancreatitis. We conDucted a prospective randomized controlled trial to evaluate the prophylactic effect of Pancreatic Duct Stenting on the frequency of post-ERCP pancreatitis in patients who underwent P-GW. Methods Seventy patients who underwent P-GW for achieving selective biliary cannulation were included in this study. Patients were randomly assigned to either the Stent group ( n = 35) or the no-Stent group ( n = 35). The Pancreatic Duct Stent used was a 5-Fr, 4-cm-long Stent with a single pigtail at the duodenal end ( Pit -Stent™). The primary endpoint was the frequency of post-ERCP pancreatitis. Results Selective biliary cannulation was achieved in 80% of the Stent group and in 94% of the no-Stent group ( P = 0.15). Post-ERCP pancreatitis occurred in 13% (9 patients; mild). Pancreatic Duct Stenting was successful in 91% of the Stent group. One patient in the Stent group developed migration of the Stent during the procedure, followed by mild pancreatitis. The frequency of post-ERCP pancreatitis in the Stent group was significantly lower than that in the no-Stent group (2.9 vs. 23%, relative risk 0.13, confidence interval 0.016, 0.95). Conclusion Pancreatic Duct Stenting after P-GW for achieving selective biliary cannulation is recommended to reduce the incidence of post-ERCP pancreatitis.
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Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio pancreatography
World Journal of Gastroenterology, 2008Co-Authors: Naotaka Fujita, Yutaka Noda, Go Kobayashi, Jun Horaguchi, Osamu Takasawa, Takashi Obana, Shinsuke Koshita, Yoshihide KannoAbstract:AIM: To investigate the frequency and risk factors for acute pancreatitis after Pancreatic guidewire placement (P-GW) in achieving cannulation of the bile Duct during endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: P-GW was performed in 113 patients in whom cannulation of the bile Duct was difficult. The success rate of biliary cannulation, the frequency and risk factors of post-ERCP pancreatitis, and the frequency of spontaneous migration of the Pancreatic Duct Stent were investigated. RESULTS: Selective biliary cannulation with P-GW was achieved in 73% of the patients. Post-ERCP pancreatitis occurred in 12% (14 patients: mild, 13; moderate, 1). Prophylactic Pancreatic Stenting was attempted in 59% of the patients. Of the 64 patients who successfully underwent Stent placement, three developed mild pancreatitis (4.7%). Of the 49 patients without Stent placement, 11 developed pancreatitis (22%: mild, 10; moderate, 1). Of the five patients in whom Stent placement was unsuccessful, two developed mild pancreatitis. Univariate and multivariate analyses revealed no Pancreatic Stenting to be the only significant risk factor for pancreatitis. Spontaneous migration of the Stent was observed within two weeks in 92% of the patients who had undergone Pancreatic Duct Stenting. CONCLUSION: P-GW is useful for achieving selective biliary cannulation. Pancreatic Duct Stenting after P-GW can reduce the incidence of post-ERCP pancreatitis, which requires evaluation by means of prospective randomized controlled trials.
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efficacy and safety of prophylactic Pancreatic Duct Stent pit Stent placement in patients at high risk of post ercp pancreatitis
Digestive Endoscopy, 2007Co-Authors: Kei Ito, Naotaka Fujita, Yutaka Noda, Go Kobayashi, Jun Horaguchi, Osamu Takasawa, Takashi ObanaAbstract:Background: The usefulness of prophylactic Pancreatic Stent placement for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been reported. We developed a new Pancreatic Duct Stent, which was a 5 Fr, 4 cm-long Stent with a single duodenal pigtail (Pit-Stent). Patients and Methods: Pancreatic Duct Stenting using a Pit-Stent was attempted in 76 patients (40 men, 36 women; mean age, 65 years; age range, 42–91 years) at high risk of post-ERCP pancreatitis. The frequency of post-ERCP pancreatitis and spontaneous passage of the Stent were investigated. Results: Pancreatic Duct Stent placement was successfully performed in 93% of the patients. One patient developed mild pancreatitis after ERCP (1.4%). Spontaneous passage of the Stent was observed in 92%. There were no other complications or procedure-related deaths in this group. Conclusions: Pancreatic Duct Stent insertion may reduce the incidence of post-ERCP pancreatitis in patients at high risk of post-ERCP pancreatitis. Spontaneous migration of a Pancreatic Stent that contributes to a lessening of the need for additional ERCP can be expected with the use of a Pit-Stent.
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EFFICACY AND SAFETY OF PROPHYLACTIC Pancreatic Duct Stent (PIT‐Stent) PLACEMENT IN PATIENTS AT HIGH RISK OF POST‐ERCP PANCREATITIS
Digestive Endoscopy, 2007Co-Authors: Kei Ito, Naotaka Fujita, Yutaka Noda, Go Kobayashi, Jun Horaguchi, Osamu Takasawa, Takashi ObanaAbstract:Background: The usefulness of prophylactic Pancreatic Stent placement for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been reported. We developed a new Pancreatic Duct Stent, which was a 5 Fr, 4 cm-long Stent with a single duodenal pigtail (Pit-Stent). Patients and Methods: Pancreatic Duct Stenting using a Pit-Stent was attempted in 76 patients (40 men, 36 women; mean age, 65 years; age range, 42–91 years) at high risk of post-ERCP pancreatitis. The frequency of post-ERCP pancreatitis and spontaneous passage of the Stent were investigated. Results: Pancreatic Duct Stent placement was successfully performed in 93% of the patients. One patient developed mild pancreatitis after ERCP (1.4%). Spontaneous passage of the Stent was observed in 92%. There were no other complications or procedure-related deaths in this group. Conclusions: Pancreatic Duct Stent insertion may reduce the incidence of post-ERCP pancreatitis in patients at high risk of post-ERCP pancreatitis. Spontaneous migration of a Pancreatic Stent that contributes to a lessening of the need for additional ERCP can be expected with the use of a Pit-Stent.
Robert H Hawes - One of the best experts on this subject based on the ideXlab platform.
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Small prophylactic Pancreatic Duct Stents: an assessment of spontaneous passage and Stent-induced Ductal abnormalities.
Endoscopy, 2007Co-Authors: Christopher Lawrence, Peter B. Cotton, Joseph Romagnuolo, K M Payne, E. Rawls, Robert H HawesAbstract:BACKGROUND AND STUDY AIMS: Placing small Stents in the Pancreatic Duct at endoscopic retrograde cholangiopancreatography reduces the risk of pancreatitis. However, this practice means that a second procedure might be required to remove the Stent, and Stents can also damage the Duct. The aims of this study were to determine the frequency of spontaneous dislodgment and to assess the incidence of Stent-induced Ductal irregularities. PATIENTS AND METHODS: We performed a retrospective analysis of consecutive patients seen over a 3-year period (2001 - 2004) who had undergone placement of a 3-Fr Pancreatic Duct Stent and in whom the fate of the Stent had been documented. Radiographs were reviewed to determine Stent passage at 30 days. If applicable, follow-up pancreatograms were reviewed to assess for Stent-induced Ductal abnormalities. Statistical analysis was performed using chi-squared and Fisher’s exact tests for proportions, and 95 % binomial confidence intervals (CI) were calculated. RESULTS: Records for 125 consecutive patients who had had 3-Fr Pancreatic Stents placed were reviewed. The Stents had passed spontaneously within 30 days in 110/125 patients (88 %). In the remaining 15 patients (12 %, 95 % CI 6.9 % - 19 %), the Stents were still present on follow-up radiographs after a median time of 36 days, (range 31 - 116 days). Stent length, Pancreatic sphincterotomy, and pancreas divisum had no effect on the likelihood of spontaneous passage. No Stent-induced Ductal irregularities were observed. CONCLUSIONS: Nearly 90 % of prophylactic 3-Fr Pancreatic Duct Stents pass spontaneously within 30 days, and these Stents were not observed to induce changes in the Pancreatic Duct.
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Pancreatic Duct Stent insertion for functional smoldering pancreatitis.
Gastrointestinal endoscopy, 2003Co-Authors: Shyam Varadarajulu, Robert H Hawes, Tara C. Noone, Peter B. CottonAbstract:Abstract Background: Some patients with smoldering pancreatitis in the absence of necrosis, pseudocyst, and Ductal disruption experience unremitting abdominal pain caused by persiStent Pancreatic inflammation. Experience with the use of Pancreatic Duct Stents in this patient population was reviewed. Patients and Methods: Data for 11 patients with smoldering pancreatitis who underwent ERCP with Pancreatic Duct Stent placement were reviewed retrospectively. All patients had severe, daily pain that worsened with ingestion of food, had required narcotic analgesics for control of pain, had lost weight, and had persiStently elevated serum levels of Pancreatic enzymes as well as Pancreatic inflammatory changes on CT (without necrosis or pseudocyst). Six patients were being treated with parenteral nutrition. Observations: The mean duration of symptoms from the onset of pancreatitis until Pancreatic Duct Stent insertion was 74 days (range 14-151 days). Stents were placed for a mean of 7 weeks (range 2-19 weeks). Pancreatic Stent placement provided permanent pain relief in 10 (91%) patients within a mean of 9 days (range 3-20 days); one patient had persiStent symptoms requiring celiac plexus blockade after 5 months. Parenteral nutrition and treatment with narcotic agents were discontinued for 10 patients within a mean of 15 days (range 7-39 days) after Pancreatic Duct insertion. Conclusions: Smoldering pancreatitis may result from functional obstruction, possibly caused by edema or spasm, of the papillary orifice. Insertion of a Stent into the Pancreatic Duct alleviates pain, enables early resumption of oral intake of food, and facilitates Pancreatic Duct drainage. It also may help to prevent complications arising from persiStent Pancreatic inflammation.
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pancreas divisum results of minor papilla sphincterotomy
Gastrointestinal Endoscopy, 1993Co-Authors: Glen A Lehman, Rod Nisi, Stuart Sherman, Robert H HawesAbstract:A subpopulation of pancreas divisum patients may have Pancreatic pain or pancreatitis as a result of a stenotic minor papilla. This study was undertaken to evaluate the efficacy of minor papilla sphincterotomy in 52 pancreas divisum patients who had disabling chronic Pancreatic pain (n=24), acute recurrent pancreatitis (n=17), or chronic pancreatitis (n=11). Patients were symptomatic for a mean time of 5.1 years and had failed to respond to conservative therapy. Minor papilla sphincterotomy was performed with a needle knife over a previously placed minor papilla/dorsal Pancreatic Duct Stent. Clinical improvement was assessed by comparison of symptoms (using a 0 to 10 scale) and number of hospital days per month required for pain or pancreatitis for an equal period of time before and after therapy. The average duration of follow-up was 1.7 years. As compared with the chronic pain and chronic pancreatitis groups, the acute recurrent pancreatitis group had a significant reDuction in the mean symptom score and number of hospital days per month. Patients with acute recurrent pancreatitis benefited from minor papilla sphincterotomy more frequently than those with chronic pancreatitis (76.5% versus 27.3%, p =0.01) or chronic pain (76.5% versus 26.1%, p =0.002). Complications followed 15% of the procedures; they consisted primarily of mild pancreatitis, although one additional patient died of a Pancreatic abscess after a failed cannulation. Fifty percent of patients evaluated at the time of Stent removal had Stent-induced dorsal Duct changes. The results of this study support the performance of minor papilla therapy in pancreas divisum patients who have acute recurrent pancreatitis. Pending methods to better predict outcome, this therapy should be avoided in patients with chronic pancreatitis or chronic Pancreatic pain.
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pancreas divisum results of minor papilla sphincterotomy
Gastrointestinal Endoscopy, 1993Co-Authors: Glen A Lehman, Rod Nisi, Stuart Sherman, Robert H HawesAbstract:A subpopulation of pancreas divisum patients may have Pancreatic pain or pancreatitis as a result of a stenotic minor papilla. This study was undertaken to evaluate the efficacy of minor papilla sphincterotomy in 52 pancreas divisum patients who had disabling chronic Pancreatic pain (n = 24), acute recurrent pancreatitis (n = 17), or chronic pancreatitis (n = 11). Patients were symptomatic for a mean time of 5.1 years and had failed to respond to conservative therapy. Minor papilla sphincterotomy was performed with a needle knife over a previously placed minor papilla/dorsal Pancreatic Duct Stent. Clinical improvement was assessed by comparison of symptoms (using a 0 to 10 scale) and number of hospital days per month required for pain or pancreatitis for an equal period of time before and after therapy. The average duration of follow-up was 1.7 years. As compared with the chronic pain and chronic pancreatitis groups, the acute recurrent pancreatitis group had a significant reDuction in the mean symptom score and number of hospital days per month. Patients with acute recurrent pancreatitis benefited from minor papilla sphincterotomy more frequently than those with chronic pancreatitis (76.5% versus 27.3%, p = 0.01) or chronic pain (76.5% versus 26.1%, p = 0.002). Complications followed 15% of the procedures; they consisted primarily of mild pancreatitis, although one additional patient died of a Pancreatic abscess after a failed cannulation. Fifty percent of patients evaluated at the time of Stent removal had Stent-induced dorsal Duct changes. The results of this study support the performance of minor papilla therapy in pancreas divisum patients who have acute recurrent pancreatitis.(ABSTRACT TRUNCATED AT 250 WORDS)
