Severe Post-ERCP Pancreatitis Following Pancreatic Duct Stenting for Needle Knife Common Bile Duct Cannulation: a Case Series and Review of Literature

Abstract

Placement of prophylactic pancreatic duct (PD) stents is a strategy to reduce the rate and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients. However, PD stents do not completely eliminate the risk of PEP. Most previous studies have shown the positive effects of PD stents on PEP reduction, especially in high-risk ERCP procedures. Here, we report seven cases of severe post-ERCP pancreatitis associated with PD stents. Needle knife cannulation technique following PD stenting was used for all cases. The PD stent that was used was a polytetrafluoroethylene, 5-Fr polyethylene single pigtail unflanged plastic PD stent (Endo-Flex GmbH, Voerde). The PD stent was inserted successfully with the first attempt and the least trauma to the pancreatic duct. In fact, the present article describes our experience of the successful placement of PD stent, but post-ERCP pancreatitis was diagnosed according to Cotton’s criteria in all the patients. Because of the long hospitalization more than 10 days for each case, the intensity of pancreatitis in all cases was considered severe.