What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis

Mamoru Takenaka, Tsuyoshi Fujita, Daisuke Sugiyama, Atsuhiro Masuda, Hideyuki Shiomi, Maki Sugimoto, Tsuyoshi Sanuki, Takanobu Hayakumo, Takeshi Azuma, Hiromu Kutsumi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Conducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. Methods The clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. Results In 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30 min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08). Conclusions Patients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.

Original languageEnglish
Pages (from-to)275-280
Number of pages6
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume21
Issue number4
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Propensity Score
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Pancreatitis
Stents
Catheterization
Randomized Controlled Trials
Odds Ratio
Ethics
Peptamen

Keywords

  • Pancreatic duct stent
  • Post-endoscopic retrograde cholangiopancreatography pancreatitis
  • Propensity score analysis

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis. / Takenaka, Mamoru; Fujita, Tsuyoshi; Sugiyama, Daisuke; Masuda, Atsuhiro; Shiomi, Hideyuki; Sugimoto, Maki; Sanuki, Tsuyoshi; Hayakumo, Takanobu; Azuma, Takeshi; Kutsumi, Hiromu.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 21, No. 4, 2014, p. 275-280.

Research output: Contribution to journalArticle

Takenaka, Mamoru ; Fujita, Tsuyoshi ; Sugiyama, Daisuke ; Masuda, Atsuhiro ; Shiomi, Hideyuki ; Sugimoto, Maki ; Sanuki, Tsuyoshi ; Hayakumo, Takanobu ; Azuma, Takeshi ; Kutsumi, Hiromu. / What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2014 ; Vol. 21, No. 4. pp. 275-280.
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abstract = "Background Conducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. Methods The clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. Results In 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95{\%} CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30 min) (odds ratio 0.13, 95{\%} CI 0.01-1.14, P = 0.08). Conclusions Patients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.",
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AU - Takenaka, Mamoru

AU - Fujita, Tsuyoshi

AU - Sugiyama, Daisuke

AU - Masuda, Atsuhiro

AU - Shiomi, Hideyuki

AU - Sugimoto, Maki

AU - Sanuki, Tsuyoshi

AU - Hayakumo, Takanobu

AU - Azuma, Takeshi

AU - Kutsumi, Hiromu

PY - 2014

Y1 - 2014

N2 - Background Conducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. Methods The clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. Results In 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30 min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08). Conclusions Patients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.

AB - Background Conducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. Methods The clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. Results In 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30 min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08). Conclusions Patients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.

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KW - Post-endoscopic retrograde cholangiopancreatography pancreatitis

KW - Propensity score analysis

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