A propensity score matching analysis of prophylactic pancreatic stent and rectal NSAIDs for prevention of post-ERCP pancreatitis

Objective To investigate the efficacy of prophylactic pancreatic stent placement and nonsteroidal antiinflammatory drugs(NSAIDs) for the prevention of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP). Methods A total of 623 patients with high risk factors for PEP were treated with prophylactic pancreatic stent placement (145 patients, group A) or rectal NSAIDs(478 patients, group B) for PEP prevention by using the propensity score matching(PSM) analysis. Incidence of PEP, moderate and severe PEP were investigated. According to risk factors of PEP, indications of prophylactic pancreatic stent placement were analysed. Results Of 623 patients with high risk factors, 145 pairs were generated after PSM.Pancreatitis occurred in 32 patients, 10 (6.9%) in group A and 22 (15.2%) in group B(P<0.05). Moderate-to-severe pancreatitis developed in 5(3.4%)patients in group A and 14(9.7%) patients in group B(P<0.05). Risk factors of post-ERCP PEP were cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and history of ampullectomy. Conclusion Although the NSAIDs represent an easy, inexpensive treatment, prophylactic pancreatic stent placement is still a better prevention strategy for PEP.Prophylactic pancreatic stents should be recommended to those with risk factors including cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and ampullectomy. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Stents; Propensity score matching