Pancreatic stenting in the prevention and combination therapy of acute pancreatitis

Aim. To evaluate the efficacy of endoscopic transpapillary pancreatic stenting in the prevention and combination therapy of acute pancreatitis.

Materials and methods. The study examined 166 cases of pancreatic duct stenting intended to prevent acute postprocedural pancreatitis in 105 patients and to provide a combination therapy for acute pancreatitis in 61 patients. In this case plastic stents (3–7 Fr) were used that were removed on days 3–5 provided neither amylasemia nor clinical signs of acute pancreatitis were observed.

Results. Pancreatic stenting performed to prevent acute post-procedural pancreatitis in 100 patients yielded good results in 95.2% of the cases; elective surgery was performed in 16 of these cases after 2 weeks. In 3.8% of the cases, some complications were observed (pancreatitis, jaundice); one (0.95%) fatal case was reported. In the combination therapy of severe pancreatitis (APACHE II >10 points), recovery was observed in 86.9% of the cases involving pancreatic duct stenting. In 11.3% of the cases, stenting was accompanied by minimally invasive surgical procedures. The disease was found to have progressed in 12 patients (19.7%). Four patients were discharged from the hospital with pancreatic fistulas, while 8 patients (13.1%) died.

Conclusion. Preventive stenting of the pancreatic duct in the setting of complicated and atypical papillosphincterotomy reduces the incidence of acute pancreatitis to 3.8% at a case fatality rate of 0.95%. Pancreatic duct stenting is indicated for treatment of pancreatic necrosis in the setting of biliary pancreatitis involving impacted stones and severe acute pancreatitis at an amylase level of > 400 U/L during the first three days of the disease.

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