Early intervention with rescue ERCP and pancreatic stenting for unanticipated post-ERCP pancreatitis: a comparative study.

OBJECTIVES

Previous studies have demonstrated that rescue endoscopic retrograde cholangiopancreatography (ERCP) effectively relieves post-ERCP pancreatitis (PEP). This study aimed to compare the therapeutic efficacy of rescue ERCP combined with conservative treatment with that of conservative treatment alone in patients with PEP.

MATERIALS AND

METHODS

In this retrospective comparative study, patients presenting with abdominal pain, significantly elevated amylase levels, and relevant imaging findings were eligible for rescue ERCP. The pain score, duration of elevated amylase levels, duration of systemic inflammatory response syndrome (SIRS), time to resume oral diet, and hospital stay were compared.

RESULTS

Thirteen patients who underwent rescue ERCP and 29 who received conservative therapy were classified into the stent and conservative groups, respectively. The median pain scores 48 h after PEP onset were significantly lower in the stent group than in the conservative treatment group (4.00 vs. 5.00, p = 0.027). Additionally, the stent group also demonstrated shorter median duration of elevated amylase levels (3.00 vs. 4.00, p = 0.01), duration of SIRS (6.00 vs. 11.00, p = 0.029), and time to resume oral diet (5.00 vs 7.00, p = 0.044). The median SIRS duration of patients who underwent rescue ERCP within 7 h was shorter than in those who underwent rescue ERCP after 7 h (5.00 vs. 10.00, p = 0.021), and the median time to resume oral diet after PEP onset was also shorter (5.00 vs. 8.50, p = 0.027).

CONCLUSIONS

Early intervention with pancreatic stenting combined with conservative treatment more effectively relieves PEP compared with conservative treatment alone. The optimal therapeutic window is approximately 7 h after PEP onset.