Emergency ERCP for Gallstone Pancreatitis

Is EST Essential?

Abstract

In the Clinical Practice Guidelines for the management of acute pancreatitis: JPN GL 2021, early endoscopic retrograde cholangiopancreatography (ERCP)/endoscopoic sphincterotomy (EST) is recommended for gallstone pancreatitis, but there is an ongoing debate about the validity of performing stent placement alone without EST for such cases. In this study, we compared cases that had received plastic stent placement alone and those that had received EST ＋ plastic stent placement for gallstone pancreatitis; the two groups comprised 19 cases each. We compared the time needed for the patients to resume normal oral intake, as the endpoint, between the two groups. In the group that received only plastic stent placement, the median age was 72 years, as compared with the median age of 64 years in the EST ＋ stent placement group, there was a higher proportion of patients with comorbidities, and a higher proportion of patients receiving antithrombotic therapy (10 cases vs. 1 case). In regard to the time to resumption of normal oral intake, there was no significant difference between the group that received stent placement alone and the group that received EST ＋ stent placement (4 days in the former group and 7 days in the latter). Therefore, we consider that plastic stent placement alone may be a valid treatment in situations where EST cannot be safely performed.