Timing And Clinical Efficacy Of Pancreatic Duct Stent Intervention In ERCP

Objective:1.To analyze serum pancreatic amylase levels after Endoscopic retrograde cholangiopancreatography(ERCP)with different times of guidewire misplacement into the pancreatic duct,and to explore the timing of pancreatic duct stent intervention.2.Pancreatic stent was inserted according to the timing of pancreatic stent intervention during ERCP,and the clinical efficacy of pancreatic stent intervention was evaluated,so as to provide reference for clinical practice.Methods: This study was divided into two parts.A total of 200 patients with common bile duct stones who underwent ERCP in Inner Mongolia Forestry General Hospital from January 2015 to December 2021 were selected.Part Ⅰ study: According to The Times of misplacement of guide wire into the pancreatic duct during ERCP,the patients were divided into 1 time group(n=43)and 1 time group(n=43).Twice group(n=40);Three times group(n=45);Four times group(n=31).The general clinical data and postoperative serum pancreatic amylase levels of the four groups of patients with different times of guide wire mistakenly entering the pancreatic duct were collected.The serum pancreatic amylase levels of different times of guide wire mistakenly entering the pancreatic duct during ERCP were analyzed to determine the timing of intraoperative pancreatic duct stent intervention.Part Ⅱ study: According to the results of the first part of the study(The guidewire in the first part of the study was mistakenly inserted into the pancreatic duct three times as the control group),the data of the second part of the study were collected.The patients with guide wire into the pancreatic duct three times were the research objects,and they were divided into the pancreatic duct stent group(n=41)and the control group(n=45).In the pancreatic stent group,a 5cm×5Fr pancreatic stent and nasobiliary drainage were placed during operation,while in the control group,only nasobiliary drainage was placed.The baseline data,serum pancreatic amylase level before ERCP,4h and 24 h after ERCP,the recovery time of pancreatic enzymes,the length of hospital stay,the incidence of abdominal pain,the incidence and severity of postoperative PEHA and Post-ERCP pancreatitis(PEP)were collected.To analyze the clinical efficacy of pancreatic duct stent intervention when the guide wire mistakenly entered the pancreatic duct during ERCP.Results:Part Ⅰ study:1.With the increase of the number of guide wire into the pancreatic duct repeatedly during ERCP,the serum level of pancreatic amylase increased significantly.The serum level of pancreatic amylase in the 3 times and 4 times groups was higher than that in the 1and 2 times groups.PEHA occurred,and the difference was statistically significant(P<0.05).The guide wire mistakenly entered the pancreatic duct 3 times and the timing of pancreatic duct stent intervention was considered.2.Analysis of risk factors related to PEHA showed that female and intraoperative guide wire misplacement into the pancreatic duct 3 times or more were risk factors for PEHA(P<0.05).Part Ⅱ study:1.Comparison of gender,age,comorbidities(such as history of cholecystectomy,hypertension and diabetes)and preoperative laboratory tests(such as white blood cell,C-reactive protein,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,alkaline phosphatase,total cholesterol,triglyceride and total bilirubin levels)between pancreatic duct stent group and control group;The difference was not statistically significant(P>0.05).There were no significant differences in intubation time,intubation times,stone size,nipple incision and balloon dilatation between the two groups(P>0.05).2.The level of serum amylase in the pancreatic stent group was lower than that in the control group at 4h and 24 h after operation(P<0.05),and the overall incidence of PEHA in the pancreatic stent group was lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative hospital stay and recovery time of pancreatic amylase in the pancreatic stent group were shorter than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative abdominal pain and PEP between the two groups(P>0.05).Compared with the control group,the severity of PEP in the pancreatic stent group was reduced,and the difference was statistically significant(P<0.05).Conclusion:1.Three times of misplacement of guidewire into pancreatic duct during ERCP is the time for pancreatic duct stent intervention during ERCP.2.The risk factors of PEHA are female and guidewire misplaced into pancreatic duct 3 or more times during operation.3.When the guide wire was misplaced into the pancreatic duct for 3 times during ERCP,pancreatic duct stent intervention can reduce the occurrence of PEHA,shorten the recovery time of pancreatic enzymes and the length of hospital stay,and reduce the severity of PEP in patients,which is safe and effective.