Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation

AIM:To investigate the need for pancreatic stenting after endoscopic sphincterotomy(EST)in patients with difficult biliary cannulation.METHODS:Between April 2008 and August 2013,2136 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)-related procedures.Among them,55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method(P-GW)were divided into two groups:a stent group(n=24;pancreatic stent placed)and a no-stent group(n=31;no pancreatic stenting).We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis(PEP)in patients undergoing EST after biliary cannulation by P-GW.RESULTS:No differences in patient characteristics or endoscopic procedures were observed between the two groups.The incidence of PEP was 4.2%(1/24)and29.0%(9/31)in the Stent and no-stent groups,respectively,with the no-stent group having a significantly higher incidence(P=0.031).The PEP severity was mild for all the patients in the stent group.In contrast,8 had mild PEP and 1 had moderate PEP in the no-stent group.The mean serum amylase levels(means±SD)3 h after ERCP(183.1±136.7 vs 463.6±510.4 IU/L,P=0.006)and on the day after ERCP(209.5±208.7vs 684.4±759.3 IU/L,P=0.002)were significantly higher in the no-stent group.A multivariate analysis identified the absence of pancreatic stenting(P=0.045;odds ratio,9.7;95%CI:1.1-90)as a significant risk factor for PEP.CONCLUSION:In patients with difficult cannulation in whom the bile duct is cannulated using P-GW,a pancreatic stent should be placed even if EST has been performed.