Effect Of Pancreatic Duct Stent Preventing Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis In High-risk Patients

Objective: To investigate the efficacy and safety of pancreatic duct stent implantation in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP)in high-risk patients.Statistical analysis of pancreatic duct drainage can reduce the incidence and severity of post-ERCP pancreatitis(PEP),whether it can reduce the incidence of hyperamylasemia,thus providing prevention of post endoscopic retrograde cholangiopancreatography pancreatitis and providing a new way to reduce the incidence of complications after endoscopic retrograde cholangiopancreatography.Methods: The clinical data of patients undergoing ERCP treatment from January 2014 to January 2017 in the biliary minimally invasive surgery of Zhongshan Hospital affiliated to Dalian University were retrospectively analyzed.Select patient data in strict accordance with the inclusion criteria and exclusion criteria,preoperative preparation is improved before surgery,intraoperative treatment is given according to the patient's combined biliary and pancreatic diseases,postoperative treatment is treated according to the disease and the patient's tolerance to surgery.The data of patients with pancreatic duct stent and those without pancreatic duct stent were collected.The blood amylase levels were compared at 12 h,24h and 48 h after operation.The incidence and severity of pancreatitis and hyperamylasemia were analyzed.To explore whether the use of pancreatic duct stent in ERCP is effective in preventing PEP and reduce the incidence of hyperamylasemia.Results: According to the strict screening criteria and statistics found that there were 110 patients were placed in the pancreatic duct stent,and 84 patients were not placed in the pancreatic duct stent.There were no significant differences in gender,age,preoperative combined underlying disease,preoperative amylase,preoperative combined acute biliary tract inflammation,and disease composition(P>0.05).Compareing of the pancreatic duct stent group and the non-stent group after operation,the blood amylase values in the pancreatic duct stent group were significantly lower than those in the non-leaved pancreatic duct stent group at 12 h,24h,and 48 h after operation(P<0.05).Diagnostic criteria according to the occurrence of Cotton diagnostic criteria PEP,Statistical analysis of the probability of patients with hyperamylasemia and PEP,compareing with the unplaced pancreatic duct stent group the incidence of hyperamylasemia in the pancreatic duct stent group was not significantly decreased(P=0.71,>0.05),the incidence of mild,moderate,and severe PEP was lower than that of the control group.In the pancreatic duct stent group,6 patients developed hyperamylasemia(6/110,5.4%)and 4 patients developed mild PEP(4/110,3.6%),no occurrence of moderate or severe pancreatitis;In the not placed in the pancreatic duct stent group,hyperamylasemia occurred in 7 patients(7/84,8.3%),PEP occurred in 11 cases(11/84,13%),moderate PEP occurred in 3 patients(3/84,3.5%),one of which developed severe pancreatitis(1/84,1.1%).There were 5 patients(5/110,4.5%)with abdominal pain after operation in the pancreatic duct stent group,and 18 patients(18/84,21.4%)who had abdominal pain after surgery without pancreatic duct stent group,the difference has statistical significance(P<0.05).The average postoperative hospital stay was(6.86±1.40)days in the pancreatic duct stent group,(8.50±4.08)days in patients without pancreatic duct stent,and the hospitalization days after ERCP in the pancreatic duct stent group were significantly shorter,the difference has statistically significant(P < 0.05).Patients with pancreatic duct stent group after ERCP were successfully removed from the pancreatic duct stent,and no complications such as stent displacement,perforation of the digestive tract,and hemorrhage were observed.There was no acute pancreatitis after the stent was removed.Conclusions: The drainage of pancreatic duct stent can reduce the incidence and severity of PEP in patients with risk factors,so it can be used as a measure to prevent PEP in high-risk patients.The occurrence of hyperamylasemia after endoscopic cholangiopancreatography rate has not decreased significantly and its effectiveness needs further study.